Provider Demographics
NPI:1184641011
Name:DUVAL, DERETHIA C (MFT)
Entity Type:Individual
Prefix:DR
First Name:DERETHIA
Middle Name:C
Last Name:DUVAL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3763
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-0763
Mailing Address - Country:US
Mailing Address - Phone:510-839-3158
Mailing Address - Fax:510-839-3158
Practice Address - Street 1:655 WESLEY AVE
Practice Address - Street 2:SUITE # 9
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3748
Practice Address - Country:US
Practice Address - Phone:510-839-3158
Practice Address - Fax:510-839-3158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 17788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health