Healthcare Provider Details

I. General information

NPI: 1508439720
Provider Name (Legal Business Name): CULTURAL CONNECTION THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 09/11/2025
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 2ND ST STE 8
DAVIS CA
95616-4666
US

IV. Provider business mailing address

719 2ND ST STE 8
DAVIS CA
95616-4666
US

V. Phone/Fax

Practice location:
  • Phone: 530-505-1994
  • Fax: 530-231-0128
Mailing address:
  • Phone: 530-505-1994
  • Fax: 530-231-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIANA NOGUEIRA
Title or Position: OWNER
Credential: LCSW
Phone: 408-416-1710