Healthcare Provider Details

I. General information

NPI: 1487718409
Provider Name (Legal Business Name): CONTRA COSTA YOUTH SERVICE BUREAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 BROADWAY
RICHMOND CA
94804-1910
US

IV. Provider business mailing address

186 BROADWAY
RICHMOND CA
94804-1949
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-7812
  • Fax: 510-231-7812
Mailing address:
  • Phone: 510-215-4670
  • Fax: 510-215-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MILDRED NAIMA WALLS-JOHNSON
Title or Position: CLINICAL MANAGER OF OPERATIONS
Credential: LMFT
Phone: 510-825-7994