Healthcare Provider Details

I. General information

NPI: 1407283385
Provider Name (Legal Business Name): BAY AREA COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 FILLMORE ST SUITE 302
SAN FRANCISCO CA
94123-3471
US

IV. Provider business mailing address

3053 FILLMORE ST # 145
SAN FRANCISCO CA
94123-4009
US

V. Phone/Fax

Practice location:
  • Phone: 415-488-6122
  • Fax:
Mailing address:
  • Phone: 415-488-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KEITH SUTTON
Title or Position: DIRECTOR
Credential: PSYD
Phone: 415-488-6122