Provider Demographics
NPI:1437740271
Name:DENNIS, KATHERINE JOHNSON (MFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOHNSON
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:11750 DUBLIN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2820
Mailing Address - Country:US
Mailing Address - Phone:925-997-4704
Mailing Address - Fax:
Practice Address - Street 1:11750 DUBLIN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2820
Practice Address - Country:US
Practice Address - Phone:925-997-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist