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General NPI Number Information
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NPI Number | 1881834505
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Entity Type | Individual
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Provider Name | GRACE C KODAMA MFT, LPCC
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Gender | Female
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Dates
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Enumeration Date | 02/21/2009
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 3001 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-2203
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Country | US
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Telephone | 510-930-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 SHORELINE DR UNIT 6013
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City | ALAMEDA
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State | CA
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Zip | 94501-6470
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Country | US
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Telephone | 510-930-0980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 497
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 58306
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 53442
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License Number State | CA
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