Basic Information
| Provider Information | |||||||||
| NPI: | 1871795021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | FAYE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2029 DURANT AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105750421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1727 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108939230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT 53772 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.