Healthcare Provider Details

I. General information

NPI: 1881834505
Provider Name (Legal Business Name): GRACE C KODAMA MFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2009
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 53RD ST
OAKLAND CA
94609-1814
US

IV. Provider business mailing address

2201 SHORELINE DR UNIT 6013
ALAMEDA CA
94501-6470
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-450-5876
Mailing address:
  • Phone: 510-930-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 58306
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT53442
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 497
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 53442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: