Provider Demographics
NPI:1164639688
Name:FELLOWS, JOANIE MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:JOANIE
Middle Name:MARIE
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N TEXAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1639
Mailing Address - Country:US
Mailing Address - Phone:707-399-4109
Mailing Address - Fax:
Practice Address - Street 1:2500 N TEXAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1639
Practice Address - Country:US
Practice Address - Phone:707-399-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist