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General NPI Number Information
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NPI Number | 1619136132
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Entity Type | Organization
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Legal Business Name | CONTRA COSTA YOUTH SERVICE BUREAU
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 700 W 1ST ST
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City | ANTIOCH
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State | CA
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Zip | 94509-1109
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Country | US
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Telephone | 925-246-0300
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Fax | 925-246-0303
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Provider Business Mailing Address
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Address Line | 186 BROADWAY
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City | RICHMOND
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State | CA
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Zip | 94804-1949
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Country | US
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Telephone | 510-215-4670
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Fax |
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Authorized Official
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Title or Position | CLINICAL MANAGER OF OPERATIONS
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Name | MILDRED NAIMA WALLS-JOHNSON
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Credential | LMFT
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Telephone | 510-825-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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