Healthcare Provider Details

I. General information

NPI: 1982452173
Provider Name (Legal Business Name): CERESTAR BEHAVIORAL HEALTH GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 S GARFIELD AVE UNIT 128
ALHAMBRA CA
91801-6891
US

IV. Provider business mailing address

88 S GARFIELD AVE UNIT 128
ALHAMBRA CA
91801-6891
US

V. Phone/Fax

Practice location:
  • Phone: 703-258-9026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFRED SUN
Title or Position: PRESIDENT
Credential: MD
Phone: 703-258-9026