Healthcare Provider Details

I. General information

NPI: 1063942472
Provider Name (Legal Business Name): BCT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: DEDRICK D WEATHERSBY LMFT

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 GALINDO ST
CONCORD CA
94520-2899
US

IV. Provider business mailing address

1455 GALINDO ST
CONCORD CA
94520-2899
US

V. Phone/Fax

Practice location:
  • Phone: (424) 285-4722
  • Fax:
Mailing address:
  • Phone: (424) 285-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DEDRICK D WEATHERSBY
Title or Position: CONSULTANT
Credential: M.S., M.ED.
Phone: 424-285-4722