Provider Demographics
NPI:1982630398
Name:SOARES-DABALOS, FLORENCE ADELINE (LMFT)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:ADELINE
Last Name:SOARES-DABALOS
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:PO BOX 221614
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-8614
Mailing Address - Country:US
Mailing Address - Phone:916-422-1436
Mailing Address - Fax:916-422-1436
Practice Address - Street 1:3112 O ST STE 7
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6579
Practice Address - Country:US
Practice Address - Phone:916-422-1436
Practice Address - Fax:916-422-1436
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist