Provider Demographics
NPI:1568534030
Name:DICKSON, JAMES DAREN (MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAREN
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WOODHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1236
Mailing Address - Country:US
Mailing Address - Phone:510-350-7545
Mailing Address - Fax:
Practice Address - Street 1:887 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2869
Practice Address - Country:US
Practice Address - Phone:415-206-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 43211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist