Healthcare Provider Details

I. General information

NPI: 1144583667
Provider Name (Legal Business Name): REACH PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 MAIN ST SUITE B
OAKLEY CA
94561-6017
US

IV. Provider business mailing address

3385 MAIN ST SUITE B
OAKLEY CA
94561-6017
US

V. Phone/Fax

Practice location:
  • Phone: 925-679-2504
  • Fax: 925-754-2002
Mailing address:
  • Phone: 925-679-2504
  • Fax: 925-754-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number070753
License Number StateCA

VIII. Authorized Official

Name: MR. MICKIE ANGELO MARCHETTI
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, RAS
Phone: 925-779-6908