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General NPI Number Information
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NPI Number | 1295042182
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Entity Type | Organization
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Legal Business Name | MS BEV ADDICTION COUNSELING AND CONSULTING SERVICES
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 6020 OLD QUARRY LOOP
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City | OAKLAND
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State | CA
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Zip | 94605-3306
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Country | US
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Telephone | 510-569-9555
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Fax | 510-569-9555
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Provider Business Mailing Address
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Address Line | PO BOX 18665
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City | OAKLAND
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State | CA
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Zip | 94619-0665
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Country | US
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Telephone | 510-569-9555
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Fax | 510-569-9555
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MS. BEVERLY DIANE TILSON
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Credential | LCI2361214
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Telephone | 510-569-9555
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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 | 03-068218
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License Number State | CA
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