Healthcare Provider Details

I. General information

NPI: 1669096426
Provider Name (Legal Business Name): FAITH IN ACTION COMMUNITY EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
STOCKTON CA
95202-3032
US

IV. Provider business mailing address

401 E MAIN ST
STOCKTON CA
95202-3032
US

V. Phone/Fax

Practice location:
  • Phone: 209-649-9241
  • Fax:
Mailing address:
  • Phone: 209-870-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA BROWN
Title or Position: CEO/OWNER
Credential: PPS, APCC
Phone: 209-649-9241