Healthcare Provider Details

I. General information

NPI: 1922130947
Provider Name (Legal Business Name): TWCA INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3468 MT DIABLO BLVD SUITE B203
LAFAYETTE CA
94549-3957
US

IV. Provider business mailing address

6 LOIS LN
LAFAYETTE CA
94549-3057
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-3902
  • Fax: 707-371-2433
Mailing address:
  • Phone: 925-283-2421
  • Fax: 707-371-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 20873
License Number StateCA

VIII. Authorized Official

Name: DR. ALISSA E. SCANLIN
Title or Position: VICE PRESIDENT
Credential: PSYD
Phone: 925-283-3902