Provider Demographics
NPI:1225582711
Name:DUGAN, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DUGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E COOLEY DR
Mailing Address - Street 2:111
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3934
Mailing Address - Country:US
Mailing Address - Phone:909-420-0413
Mailing Address - Fax:909-514-0410
Practice Address - Street 1:1430 E COOLEY DR
Practice Address - Street 2:111
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3934
Practice Address - Country:US
Practice Address - Phone:909-420-0413
Practice Address - Fax:909-514-0410
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2639101YP2500X
CA91123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional