Provider Demographics
NPI:1346601747
Name:DORNIG, KATRINA ANN (LMFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ANN
Last Name:DORNIG
Suffix:
Gender:F
Credentials:LMFT, PHD
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 3216
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90078-3216
Mailing Address - Country:US
Mailing Address - Phone:310-993-5064
Mailing Address - Fax:
Practice Address - Street 1:143 N LARCHMONT BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3704
Practice Address - Country:US
Practice Address - Phone:310-993-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist