Provider Demographics
NPI:1376884247
Name:DUCKWORTH-OUELLET, DAWN LORRAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:LORRAINE
Last Name:DUCKWORTH-OUELLET
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 1:5927 E CREEKSIDE AVE
Mailing Address - Street 2:UNIT 9
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3186
Mailing Address - Country:US
Mailing Address - Phone:714-454-3672
Mailing Address - Fax:714-532-2290
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:SUITE D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3335
Practice Address - Country:US
Practice Address - Phone:714-454-3672
Practice Address - Fax:714-532-2290
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist