Healthcare Provider Details

I. General information

NPI: 1144532581
Provider Name (Legal Business Name): ALECIA RAE JEPPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALECIA MOWER JEPPSON LCSW

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CENTRAL AVE
TRACY CA
95376-4104
US

IV. Provider business mailing address

4464 LONE TREE WAY # 1069
ANTIOCH CA
94531-7413
US

V. Phone/Fax

Practice location:
  • Phone: 209-820-1500
  • Fax:
Mailing address:
  • Phone: 209-820-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 26480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number59242373501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: