Healthcare Provider Details

I. General information

NPI: 1992440820
Provider Name (Legal Business Name): LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MOUNT HAMILTON DR
ANTIOCH CA
94531-8518
US

IV. Provider business mailing address

150 LINDEN ST
OAKLAND CA
94607-2538
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4700
  • Fax:
Mailing address:
  • Phone: 510-273-4700
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON STAULCUP BECWAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 510-273-4700