Healthcare Provider Details

I. General information

NPI: 1619563293
Provider Name (Legal Business Name): THERICA M MCCORD APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 BRODER BLVD
DUBLIN CA
94568-3309
US

IV. Provider business mailing address

PO BOX 1383
OAKLAND CA
94604-1383
US

V. Phone/Fax

Practice location:
  • Phone: 707-789-1555
  • Fax:
Mailing address:
  • Phone: 707-789-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11734
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: