Healthcare Provider Details

I. General information

NPI: 1396868709
Provider Name (Legal Business Name): JOHN M SEBOLD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 COUNTY HOSPITAL RD STE 109
QUINCY CA
95971-9126
US

IV. Provider business mailing address

270 COUNTY HOSPITAL RD STE 109
QUINCY CA
95971-9126
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-6307
  • Fax: 530-283-6045
Mailing address:
  • Phone: 530-283-6307
  • Fax: 530-283-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: