Healthcare Provider Details

I. General information

NPI: 1366082950
Provider Name (Legal Business Name): LATRONDA SHAWN LUMPKINS MSW, MBA, ASW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRMOUNT DRIVE BLDG B
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

2050 FAIRMOUNT DRIVE BLDG B
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-3030
  • Fax: --
Mailing address:
  • Phone: 510-483-3030
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW104070
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW104070
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: