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General NPI Number Information
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NPI Number | 1962378257
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Entity Type | Organization
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Legal Business Name | ID MARRIAGE & FAMILY THERAPY PC
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1941 JACKSON ST STE 20
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City | OAKLAND
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State | CA
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Zip | 94612-4600
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Country | US
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Telephone | 213-534-7324
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Fax |
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Provider Business Mailing Address
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Address Line | 1432 3RD AVE APT 2
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City | OAKLAND
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State | CA
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Zip | 94606-2266
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Country | US
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Telephone | 916-710-1959
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | INERTIA DEWITT
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Credential | LMFT
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Telephone | 213-534-7324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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