Healthcare Provider Details

I. General information

NPI: 1306356829
Provider Name (Legal Business Name): ELIA R RANK LPCC 10208
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

IV. Provider business mailing address

1430 WILLOW PASS RD
CONCORD CA
94520-7928
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5774
  • Fax:
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-259-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC4961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC4961
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC10208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: