Provider Demographics
NPI:1366684276
Name:DUNN, CAROLYN B (MA, MFT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
Last Name:DUNN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 EL MERCADO PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1301
Mailing Address - Country:US
Mailing Address - Phone:707-571-1714
Mailing Address - Fax:707-433-8854
Practice Address - Street 1:5213 EL MERCADO PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1301
Practice Address - Country:US
Practice Address - Phone:707-571-1714
Practice Address - Fax:707-433-8854
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist