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General NPI Number Information
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NPI Number | 1124468145
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Entity Type | Organization
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Legal Business Name | G.O.A.L.S. FOR WOMEN
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 1217 DEL PASO BLVD STE A
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City | SACRAMENTO
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State | CA
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Zip | 95815-3660
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Country | US
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Telephone | 916-621-3783
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Fax | 888-847-9365
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Provider Business Mailing Address
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Address Line | 1217 DEL PASO BLVD STE A
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City | SACRAMENTO
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State | CA
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Zip | 95815-3660
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Country | US
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Telephone | 916-621-3783
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Fax | 888-847-9365
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Authorized Official
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Title or Position | EXECUTIVE/CLINICAL DIRECTOR/CEO
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Name | MS. GWENDOLYN R WILSON
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Credential | LCSW
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Telephone | 510-334-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCS 24677
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | LCS 24677
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 24677
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License Number State | CA
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