Basic Information
| Provider Information | |||||||||
| NPI: | 1215050687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESHIMA | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | JOAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3075 ADELINE ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1947 CENTER ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108481112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 02/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT41440 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.