Provider Demographics
NPI:1902605066
Name:DARENSBOURG, JODIE DANIELLE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:DANIELLE
Last Name:DARENSBOURG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 NICOL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3100
Mailing Address - Country:US
Mailing Address - Phone:562-303-2704
Mailing Address - Fax:
Practice Address - Street 1:3114 NICOL AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3100
Practice Address - Country:US
Practice Address - Phone:562-303-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health