Healthcare Provider Details

I. General information

NPI: 1851969059
Provider Name (Legal Business Name): NORTH STATE SOCIAL WORK & PSYCHOTHERAPY SERVICES INC A LICEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 PINE ST STE 21
REDDING CA
96001-0750
US

IV. Provider business mailing address

859 WASHINGTON ST PMB 203
RED BLUFF CA
96080-2704
US

V. Phone/Fax

Practice location:
  • Phone: 530-638-2067
  • Fax: 949-561-5392
Mailing address:
  • Phone: 530-638-2067
  • Fax: 949-561-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JANTINA THOMPSON
Title or Position: CEO / PRESIDENT
Credential: LCSW
Phone: 530-638-2067