Healthcare Provider Details

I. General information

NPI: 1902464209
Provider Name (Legal Business Name): DIANA NORTHNESS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 LAKEWOOD DR
WINDSOR CA
95492-7856
US

IV. Provider business mailing address

8911 LAKEWOOD DR STE 24C
WINDSOR CA
95492-7856
US

V. Phone/Fax

Practice location:
  • Phone: 805-232-4161
  • Fax:
Mailing address:
  • Phone: 805-232-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: