Provider Demographics
NPI:1679649164
Name:RE, DEANNA F (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:F
Last Name:RE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ORANGE DR
Mailing Address - Street 2:SUITE S
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3108
Mailing Address - Country:US
Mailing Address - Phone:707-452-0601
Mailing Address - Fax:717-448-8416
Practice Address - Street 1:630 ORANGE DRIVE
Practice Address - Street 2:SUITE S
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-452-0601
Practice Address - Fax:707-448-8416
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist