Provider Demographics
NPI:1821245580
Name:WRIGHT, DAHLIA LOCKE
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:LOCKE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAHLIA
Other - Middle Name:
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 460465
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94146-0465
Mailing Address - Country:US
Mailing Address - Phone:707-701-3618
Mailing Address - Fax:415-524-2426
Practice Address - Street 1:1652 W TEXAS ST STE 131
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6084
Practice Address - Country:US
Practice Address - Phone:707-701-3618
Practice Address - Fax:415-524-2426
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT# 49685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist