Basic Information
| Provider Information | |||||||||
| NPI: | 1689097602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUKE | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUKE | ||||||||
| OtherFirstName: | DONA JOSEPHA | ||||||||
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| OtherCredential: | MFTI | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6240 WHITSETT AVE APT 104 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188256040 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2730 SALVIO ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945192599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256870374 | ||||||||
| FaxNumber: | 9256872695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2014 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 75707 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.