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General NPI Number Information
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NPI Number | 1497247977
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Entity Type | Organization
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Legal Business Name | SISTER-TO-SISTER 2, INC.
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 2363A SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94612-1136
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Country | US
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Telephone | 510-891-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 2363A SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94612-1136
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Country | US
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Telephone | 510-891-0464
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JETAUN G MILLS
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Credential | MA, LMFT
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Telephone | 510-891-0464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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