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General NPI Number Information
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NPI Number | 1639641772
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Entity Type | Individual
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Provider Name | JORDONA SANTIAGO-STOUT
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Gender | Female
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 559 16TH ST
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City | OAKLAND
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State | CA
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Zip | 94612-1515
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Country | US
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Telephone | 510-238-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CORTE LADO
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City | MARTINEZ
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State | CA
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Zip | 94553-2110
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Country | US
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Telephone | 925-497-3069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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