Provider Demographics
NPI:1386340677
Name:BOUIE, JANINE
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:BOUIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7894 NEY ST.
Mailing Address - Street 2:G OFFICE
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605
Mailing Address - Country:US
Mailing Address - Phone:707-384-9496
Mailing Address - Fax:
Practice Address - Street 1:7894 NEY AVE OFC
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3491
Practice Address - Country:US
Practice Address - Phone:707-384-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional