Healthcare Provider Details

I. General information

NPI: 1396598173
Provider Name (Legal Business Name): PEERS ENVISIONING AND ENGAGING IN RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8393 CAPWELL DR STE 240
OAKLAND CA
94621-2123
US

IV. Provider business mailing address

8393 CAPWELL DR STE 240
OAKLAND CA
94621-2123
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-7337
  • Fax:
Mailing address:
  • Phone: 510-832-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER LEE VANAMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-567-7612