Provider Demographics
NPI:1730644097
Name:PICKETT, DOROTHY COX (LMFT, MFC 36262)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:COX
Last Name:PICKETT
Suffix:
Gender:F
Credentials:LMFT, MFC 36262
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST STE J101
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7918
Mailing Address - Country:US
Mailing Address - Phone:949-735-6880
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE J101
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7918
Practice Address - Country:US
Practice Address - Phone:949-735-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist