Provider Demographics
NPI:1750443388
Name:GROCE, DOROTHY JEAN (MA,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:JEAN
Last Name:GROCE
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W APRICOT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5624
Mailing Address - Country:US
Mailing Address - Phone:805-757-7368
Mailing Address - Fax:805-736-6396
Practice Address - Street 1:3775 CONSTELLATION RD STE 3
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-0430
Practice Address - Country:US
Practice Address - Phone:805-733-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist