Healthcare Provider Details

I. General information

NPI: 1992415236
Provider Name (Legal Business Name): JACQUELINE CHRISTINA DUARTE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 MESA VERDE DR E APT X215
COSTA MESA CA
92626-5094
US

IV. Provider business mailing address

2775 MESA VERDE DR E APT X215
COSTA MESA CA
92626-5094
US

V. Phone/Fax

Practice location:
  • Phone: 925-980-0291
  • Fax:
Mailing address:
  • Phone: 925-980-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: