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General NPI Number Information
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NPI Number | 1760342414
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Entity Type | Organization
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Legal Business Name | SUN RIDGE PSYCHOTHERAPY CLINIC LICENSED CLINICAL SOCIAL WORKER CORP.
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3130 E VICTORIA DR
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City | ALPINE
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State | CA
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Zip | 91901-3677
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Country | US
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Telephone | 707-495-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 E VICTORIA DR
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City | ALPINE
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State | CA
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Zip | 91901-3677
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Country | US
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Telephone | 707-495-4236
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Fax | 855-975-2985
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. MELISSA JANE JONES
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Credential | PHD, LCSW
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Telephone | 707-495-4236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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