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General NPI Number Information
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NPI Number | 1073772711
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Entity Type | Organization
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Legal Business Name | VILLAGE COUNSELING & ASSESSMENT CENTER A PSYCHOLOGICAL SERVICES CLINIC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 1955 MOUNTAIN BLVD STE 111
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City | OAKLAND
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State | CA
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Zip | 94611-2830
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Country | US
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Telephone | 510-339-8221
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Fax | 510-339-8223
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Provider Business Mailing Address
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Address Line | 1955 MOUNTAIN BLVD STE 111
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City | OAKLAND
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State | CA
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Zip | 94611-2830
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Country | US
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Telephone | 510-339-8221
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Fax | 510-339-8223
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. AHMED M DARWISH
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Credential | PSYD, JD
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Telephone | 510-339-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20965
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License Number State | CA
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