Healthcare Provider Details

I. General information

NPI: 1023557519
Provider Name (Legal Business Name): DUNAMIS CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 VICTOR AVE STE B
REDDING CA
96003-4856
US

IV. Provider business mailing address

1465 VICTOR AVE STE B
REDDING CA
96003-4856
US

V. Phone/Fax

Practice location:
  • Phone: 530-338-0087
  • Fax: 530-745-6053
Mailing address:
  • Phone: 530-338-0087
  • Fax: 530-745-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number82913
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number82913
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number82913
License Number StateCA

VIII. Authorized Official

Name: JILL MARIE SHEPHERD PIERCY CLARK
Title or Position: OWNER /AUTHORIZED OFFICIAL
Credential: LMFT
Phone: 530-338-0087