Healthcare Provider Details

I. General information

NPI: 1528115227
Provider Name (Legal Business Name): MR. MARC C MCCOY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 LINCOLN AVE
OAKLAND CA
94602-2529
US

IV. Provider business mailing address

8227 OUTLOOK AVE
OAKLAND CA
94605-3540
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax: 510-531-8498
Mailing address:
  • Phone: 510-867-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: