Provider Demographics
NPI:1841484870
Name:JABUKA, PATRICIA L (MARRIAGE FAMILY COUN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:JABUKA
Suffix:
Gender:F
Credentials:MARRIAGE FAMILY COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 CONTRA COSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3054
Mailing Address - Country:US
Mailing Address - Phone:925-935-7463
Mailing Address - Fax:925-946-9120
Practice Address - Street 1:1410 DANZIG PLZ
Practice Address - Street 2:SUITE 250
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7979
Practice Address - Country:US
Practice Address - Phone:925-676-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINTERN #53545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist