Healthcare Provider Details

I. General information

NPI: 1902028699
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIORAL HEATLH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N AURORA ST STE 3
STOCKTON CA
95202-2276
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-3720
  • Fax: 209-468-8640
Mailing address:
  • Phone: 209-468-0651
  • Fax: 209-468-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number390002DN
License Number StateCA

VIII. Authorized Official

Name: GENEVIEVE VALENTINE
Title or Position: DIRECTOR-BEHAVIORAL HEALTH SERVICES
Credential: LMFT
Phone: 209-468-8750