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General NPI Number Information
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NPI Number | 1851969059
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Entity Type | Organization
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Legal Business Name | NORTH STATE SOCIAL WORK & PSYCHOTHERAPY SERVICES INC A LICEN
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 1135 PINE ST STE 21
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City | REDDING
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State | CA
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Zip | 96001-0750
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Country | US
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Telephone | 530-638-2067
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Fax | 949-561-5392
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Provider Business Mailing Address
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Address Line | 859 WASHINGTON ST # 203
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City | RED BLUFF
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State | CA
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Zip | 96080-2704
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Country | US
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Telephone | 530-638-2067
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Fax | 949-561-5392
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | JANTINA THOMPSON
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Credential | LCSW
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Telephone | 530-638-2067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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