Healthcare Provider Details

I. General information

NPI: 1316485550
Provider Name (Legal Business Name): LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SKYLINE BLVD
OAKLAND CA
94619-2497
US

IV. Provider business mailing address

150 LINDEN ST
OAKLAND CA
94607-2538
US

V. Phone/Fax

Practice location:
  • Phone: 510-482-7109
  • Fax: 510-482-7296
Mailing address:
  • Phone: 510-852-0130
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON STAULCUP BECWAR
Title or Position: CHIEF PROGRAM OFFICER
Credential: LCSW
Phone: 510-273-4700