Provider Demographics
NPI:1376083626
Name:DUBOIS, DIANE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ANDRIEUX ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6920
Mailing Address - Country:US
Mailing Address - Phone:415-405-6186
Mailing Address - Fax:
Practice Address - Street 1:2140 SUTTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3120
Practice Address - Country:US
Practice Address - Phone:415-405-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC30808OtherSTATE LICENSE NUMBER