Provider Demographics
NPI:1891839304
Name:DECOUDREAUX, MARION GAINES (MFT)
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:GAINES
Last Name:DECOUDREAUX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927A SHATTUCK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-540-4859
Mailing Address - Fax:510-336-2700
Practice Address - Street 1:2927A SHATTUCK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-540-4859
Practice Address - Fax:510-336-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist