Healthcare Provider Details

I. General information

NPI: 1083888903
Provider Name (Legal Business Name): CALIFORNIA EDUCATION AND PREVENTION PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 5TH ST SUITE 306
OAKLAND CA
94607-3840
US

IV. Provider business mailing address

499 5TH ST SUITE 306
OAKLAND CA
94607-3840
US

V. Phone/Fax

Practice location:
  • Phone: 510-874-7850
  • Fax:
Mailing address:
  • Phone: 510-874-7850
  • Fax: 510-839-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. GLORIA JEAN LOCKETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-874-7850