Healthcare Provider Details

I. General information

NPI: 1720856743
Provider Name (Legal Business Name): HUMBOLDT COMMUNITY ACCESS AND RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 E ST STE 2
EUREKA CA
95501-7621
US

IV. Provider business mailing address

1707 E ST STE 2
EUREKA CA
95501-7621
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-7077
  • Fax:
Mailing address:
  • Phone: 707-443-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: PENNIE SUE LOCKLIN-LEE
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 707-443-7077