Provider Demographics
NPI:1396250866
Name:CENTER FOR DOMESTIC PEACE
Entity type:Organization
Organization Name:CENTER FOR DOMESTIC PEACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-526-2550
Mailing Address - Street 1:734 A ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3923
Mailing Address - Country:US
Mailing Address - Phone:415-457-2464
Mailing Address - Fax:415-457-6457
Practice Address - Street 1:734 A ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3923
Practice Address - Country:US
Practice Address - Phone:415-457-2464
Practice Address - Fax:415-457-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty