Healthcare Provider Details

I. General information

NPI: 1669097457
Provider Name (Legal Business Name): DINA L SANDERS-MAYFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINA L MAYFIELD MAYFIELD

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 03/05/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

IV. Provider business mailing address

PO BOX 2433
FAIRFIELD CA
94533-0243
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-5744
  • Fax: 707-425-5162
Mailing address:
  • Phone: 510-326-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7876
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: