Provider Demographics
NPI:1902216799
Name:NEWDAWN MARRIAGE & FAMILY THERAPY, A PROF. CORP.
Entity type:Organization
Organization Name:NEWDAWN MARRIAGE & FAMILY THERAPY, A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT, JD
Authorized Official - Phone:310-948-2801
Mailing Address - Street 1:5638 MIDDLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4069
Mailing Address - Country:US
Mailing Address - Phone:310-948-2801
Mailing Address - Fax:
Practice Address - Street 1:155 GRANADA ST
Practice Address - Street 2:SUITE N
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7866
Practice Address - Country:US
Practice Address - Phone:805-987-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty