Healthcare Provider Details

I. General information

NPI: 1770935819
Provider Name (Legal Business Name): CENTER FOR PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

IV. Provider business mailing address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9540
  • Fax: 925-757-9024
Mailing address:
  • Phone: 925-777-9540
  • Fax: 925-757-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberPSY15066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. WESLEY ROBINSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 925-628-3556