Provider Demographics
NPI:1104499011
Name:BARRETT, CAROL MARIE (AMFT/APCC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT/APCC
Mailing Address - Street 1:166 SANTA CLARA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1323
Mailing Address - Country:US
Mailing Address - Phone:510-200-8410
Mailing Address - Fax:
Practice Address - Street 1:166 SANTA CLARA AVE STE 205
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1323
Practice Address - Country:US
Practice Address - Phone:510-200-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13539101YP2500X
CA138302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional