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General NPI Number Information
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NPI Number | 1023831344
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Entity Type | Organization
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Legal Business Name | GENERATIONS OF GRACE
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1800 SUTTER ST STE 500
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City | CONCORD
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State | CA
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Zip | 94520-2587
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Country | US
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Telephone | 310-595-0248
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Fax |
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Provider Business Mailing Address
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Address Line | 2070 N BROADWAY UNIT 5415
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City | WALNUT CREEK
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State | CA
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Zip | 94596-2057
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Country | US
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Telephone | 310-595-0248
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Fax |
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Authorized Official
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Title or Position | FOUNDER / PEER SUPPORT SPECIALIST
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Name | MRS. NICOLE ASHLEY BRONSON
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Credential |
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Telephone | 310-595-0248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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