Healthcare Provider Details

I. General information

NPI: 1639701857
Provider Name (Legal Business Name): JOURNEY TO NEW BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 SANTA RITA RD UNIT H188
PLEASANTON CA
94566-4779
US

IV. Provider business mailing address

1807 SANTA RITA RD UNIT H188
PLEASANTON CA
94566-4779
US

V. Phone/Fax

Practice location:
  • Phone: 92-540-0333
  • Fax:
Mailing address:
  • Phone: 92-540-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ACOSTA
Title or Position: OWNER
Credential:
Phone: 925-400-3330