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General NPI Number Information
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NPI Number | 1699024869
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Entity Type | Individual
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Provider Name | ANNIE KNAZS JUNG M.A., LPCC,
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 613 1ST ST SUITE 217
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City | BRENTWOOD
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State | CA
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Zip | 94513-1397
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Country | US
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Telephone | 925-392-5967
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Fax | 925-626-4237
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Provider Business Mailing Address
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Address Line | 174 PESCARA BLVD
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City | BRENTWOOD
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State | CA
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Zip | 94513-2991
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Country | US
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Telephone | 925-759-7200
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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 | 101
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License Number State | CA
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