Provider Demographics
NPI:1689286338
Name:VELAZQUEZ, DINA ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:ROSE
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LEMON PEPPER PL
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-8948
Mailing Address - Country:US
Mailing Address - Phone:510-504-2919
Mailing Address - Fax:
Practice Address - Street 1:500 LEMON PEPPER PL
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-8948
Practice Address - Country:US
Practice Address - Phone:510-504-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist