Provider Demographics
NPI:1669097457
Name:SANDERS-MAYFIELD, DINA L
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:L
Last Name:SANDERS-MAYFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:L
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAYFIELD
Mailing Address - Street 1:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0243
Mailing Address - Country:US
Mailing Address - Phone:510-326-4393
Mailing Address - Fax:
Practice Address - Street 1:801 EMPIRE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5702
Practice Address - Country:US
Practice Address - Phone:707-425-5744
Practice Address - Fax:707-425-5162
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7876101YP2500X
CA119230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional