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General NPI Number Information
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NPI Number | 1962077644
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Entity Type | Organization
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Legal Business Name | COLLEGE COMMUNITY SERVICES
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 2821 H ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-1913
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Country | US
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Telephone | 661-546-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 4821 KATELLA AVE SUITE 201
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City | LOS ALAMITOS
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State | CA
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Zip | 90720
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Country | US
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Telephone | 661-546-6365
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Fax |
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Authorized Official
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Title or Position | MFT TRAINEE
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Name | AMY DIANE SANCHEZ
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Credential |
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Telephone | 661-546-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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