Provider Demographics
NPI:1710543160
Name:DOTSON, ANGELA CLAIRE (LMFT 112318)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CLAIRE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LMFT 112318
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SIR FRANCIS DRAKE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1454
Mailing Address - Country:US
Mailing Address - Phone:510-776-5885
Mailing Address - Fax:510-373-6417
Practice Address - Street 1:1044 SIR FRANCIS DRAKE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1454
Practice Address - Country:US
Practice Address - Phone:510-776-5885
Practice Address - Fax:510-776-5885
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health