Healthcare Provider Details

I. General information

NPI: 1194446773
Provider Name (Legal Business Name): NORTH STATE FAMILY COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 VICTOR AVE STE A2
REDDING CA
96002-1454
US

IV. Provider business mailing address

2628 VICTOR AVE STE A2
REDDING CA
96002-1454
US

V. Phone/Fax

Practice location:
  • Phone: 530-378-4855
  • Fax:
Mailing address:
  • Phone: 530-450-2673
  • Fax: 530-237-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAECHEL LYNNE CALLEJO
Title or Position: CEO
Credential: LMFT
Phone: 530-378-4855