Healthcare Provider Details

I. General information

NPI: 1427701622
Provider Name (Legal Business Name): THE CHURCH OF TRUTH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N SUTTER ST STE 216
STOCKTON CA
95202-2900
US

IV. Provider business mailing address

PO BOX 1072
STOCKTON CA
95201-1072
US

V. Phone/Fax

Practice location:
  • Phone: 209-718-9828
  • Fax:
Mailing address:
  • Phone: 209-718-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL CHEVONNE THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: ACSW
Phone: 209-718-9828