Provider Demographics
NPI:1205905296
Name:DEVRIES, CARA MARIE (CARA DEVRIES)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:CARA DEVRIES
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:MARIE
Other - Last Name:SOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1082 ERICA RD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1082 ERICA RD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3747
Practice Address - Country:US
Practice Address - Phone:415-383-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist