Healthcare Provider Details

I. General information

NPI: 1861337826
Provider Name (Legal Business Name): ALICIA MATTOX-GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 ADELINE ST
BERKELEY CA
94703-2407
US

IV. Provider business mailing address

1042 JEWETT AVE
PITTSBURG CA
94565-6215
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-0203
  • Fax: 510-601-4002
Mailing address:
  • Phone: 510-601-0203
  • Fax: 510-601-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: