Healthcare Provider Details

I. General information

NPI: 1750443388
Provider Name (Legal Business Name): DOROTHY JEAN GROCE M.A.,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 CONSTELLATION RD STE 3
LOMPOC CA
93436-0430
US

IV. Provider business mailing address

1426 W APRICOT AVE
LOMPOC CA
93436-5624
US

V. Phone/Fax

Practice location:
  • Phone: 805-733-1916
  • Fax:
Mailing address:
  • Phone: 805-757-7368
  • Fax: 805-736-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43265
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: