Provider Demographics
NPI:1235737271
Name:DULBERG, JEANNIE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:DULBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:DULBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:540 WAGNON RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9204
Mailing Address - Country:US
Mailing Address - Phone:707-478-4561
Mailing Address - Fax:
Practice Address - Street 1:540 WAGNON RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9204
Practice Address - Country:US
Practice Address - Phone:707-892-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37671101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor