Provider Demographics
NPI:1689097602
Name:DUKE, JO
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:DUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONA JOSEPHA
Other - Middle Name:
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:6240 WHITSETT AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3162
Mailing Address - Country:US
Mailing Address - Phone:818-825-6040
Mailing Address - Fax:
Practice Address - Street 1:2730 SALVIO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2599
Practice Address - Country:US
Practice Address - Phone:925-687-0374
Practice Address - Fax:925-687-2695
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist