Provider Demographics
NPI:1184878886
Name:THEODORE, DAWN (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:THEODORE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 COLD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2210
Mailing Address - Country:US
Mailing Address - Phone:818-679-6204
Mailing Address - Fax:818-224-2728
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:SUITE 217
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-679-6204
Practice Address - Fax:818-224-2728
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist