| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 750 Birch Ct, Galt, California |
| Authorized Official Name and Position | Robert Lea (DIRECTOR) |
| Authorized Official Contact | 2094683720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
620 N Aurora St Ste 1 Stockton CA 95202-2276 Ph: (209) 468-3823 | 750 Birch Ct Galt CA 95632-8768 Ph: (209) 745-4370 |
| NPI Number | 1437270733 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437270733 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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