MEDICARE: A SOBER CHOICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY27577	CA

General Provider Information

NPI Number	:	1083194674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SOBER CHOICE

Provider Business Mailing Address
First Line	:	1271 WASHINGTON AVE # 445
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3646
Country	:	US
Telephone Number	:	510-610-9360
Fax Number	:	510-969-7932

Provider Business Practice Location Address
First Line	:	1271 WASHINGTON AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3646
Country	:	US
Telephone Number	:	510-610-9360
Fax Number	:	510-969-7932

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. NAJJUMA ZAKIYA SHURN
Credential	:	PSYD
Telephone Number	:	510-420-1800

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/15/2024

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Directions to “A SOBER CHOICE ” Practice Location

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