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General NPI Number Information
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NPI Number | 1154135234
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Entity Type | Organization
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Legal Business Name | CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 425 N EL DORADO ST
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City | STOCKTON
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State | CA
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Zip | 95202-1951
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Country | US
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Telephone | 209-937-5614
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Fax |
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Provider Business Mailing Address
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Address Line | 425 N EL DORADO ST
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City | STOCKTON
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State | CA
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Zip | 95202-1951
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Country | US
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Telephone | 209-937-5614
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORA LARSON
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Credential | ASW
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Telephone | 209-937-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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