Healthcare Provider Details

I. General information

NPI: 1215375845
Provider Name (Legal Business Name): DAWN DAABUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENTS DR
SAN RAFAEL CA
94903
US

IV. Provider business mailing address

270 EAST LN
BURLINGAME CA
94010-2802
US

V. Phone/Fax

Practice location:
  • Phone: 415-507-2000
  • Fax:
Mailing address:
  • Phone: 877-505-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84406
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84406
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number126627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: