Provider Demographics
NPI:1881834505
Name:KODAMA, GRACE C (MFT, LPCC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:KODAMA
Suffix:
Gender:F
Credentials:MFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SHORELINE DR UNIT 6013
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6470
Mailing Address - Country:US
Mailing Address - Phone:510-930-0980
Mailing Address - Fax:
Practice Address - Street 1:3001 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2203
Practice Address - Country:US
Practice Address - Phone:510-930-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 497101YP2500X
CAIMF 58306106H00000X
CAMFC 53442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional