=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326867680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GROWTH CENTER I INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2024
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9245 LAGUNA SPRINGS DR STE 200
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-800-6293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9245 LAGUNA SPRINGS DR STE 200
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-800-6293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. CLARA A BROWN
-----------------------------------------------------
Credential | M.S. COUNSELING PSYC
-----------------------------------------------------
Telephone | 916-800-6293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------