Healthcare Provider Details

I. General information

NPI: 1760501449
Provider Name (Legal Business Name): ARCHIE L GILCHRIST LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

IV. Provider business mailing address

6049 CAROLINA CIR
STOCKTON CA
95219-3970
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-4931
  • Fax:
Mailing address:
  • Phone: 209-468-4031
  • Fax: 209-468-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 20608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: