Healthcare Provider Details

I. General information

NPI: 1962062745
Provider Name (Legal Business Name): CONTRA COSTA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 BRICKYARD COVE RD STE 111
POINT RICHMOND CA
94801-4112
US

IV. Provider business mailing address

50 DOUGLAS DR STE 310
MARTINEZ CA
94553-4003
US

V. Phone/Fax

Practice location:
  • Phone: 510-215-6009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID D. LEE
Title or Position: DEPUTY CFO
Credential: MBA, FHFMA
Phone: 925-957-5445