Provider Demographics
NPI:1376601823
Name:COX, DENEE ANTIONETTE (AMFT,LPHA)
Entity Type:Individual
Prefix:
First Name:DENEE
Middle Name:ANTIONETTE
Last Name:COX
Suffix:
Gender:F
Credentials:AMFT,LPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 BROCKTON PL
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-9785
Mailing Address - Country:US
Mailing Address - Phone:707-639-0427
Mailing Address - Fax:
Practice Address - Street 1:629 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4567
Practice Address - Country:US
Practice Address - Phone:510-318-6112
Practice Address - Fax:510-569-4589
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952697732Medicaid