Provider Demographics
NPI:1457510372
Name:CARR, DENA NICOLE (ASSOCIATE MFT)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:NICOLE
Last Name:CARR
Suffix:
Gender:F
Credentials:ASSOCIATE MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70653
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-7653
Mailing Address - Country:US
Mailing Address - Phone:626-200-0792
Mailing Address - Fax:
Practice Address - Street 1:27261 LAS RAMBLAS STE 220
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6468
Practice Address - Country:US
Practice Address - Phone:909-980-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA171M00000X
CA119088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7601AOtherHATHAWAY-SYCAMORE