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General NPI Number Information
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NPI Number | 1891189403
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Entity Type | Organization
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Legal Business Name | VALLEY COMMUNITY COUSELING SERVICES
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 1300 W. LODI STE G-2
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City | STOCKTON
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State | CA
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Zip | 95240
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Country | US
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Telephone | 209-334-2126
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Fax | 209-369-8406
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Provider Business Mailing Address
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Address Line | 1300 W LODI AVE STE G2
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City | LODI
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State | CA
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Zip | 95242-3037
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Country | US
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Telephone | 209-334-2126
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Fax | 209-369-8406
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Authorized Official
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Title or Position | COUNSELOF
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Name | PATRICIA P MADRID
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Credential | RASI
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Telephone | 209-334-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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