| Evolve Family Therapy Pc | |
|
359 W 11th St Ste A1 Tracy CA 95376-3863 | |
| (209) 603-2929 | |
| Not Available |
| Full Name | Evolve Family Therapy Pc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 359 W 11th St Ste A1, Tracy, California |
| Authorized Official Name and Position | Joni Lea Dickson Garcia (CLINICIAN/COE) |
| Authorized Official Contact | 2096032929 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Family Therapy Pc 3021 Balboa Dr Tracy CA 95376-1905 Ph: (209) 603-2929 | Evolve Family Therapy Pc 359 W 11th St Ste A1 Tracy CA 95376-3863 Ph: (209) 603-2929 |
| NPI Number | 1194230086 |
|---|---|
| Provider Enumeration Date | 12/13/2017 |
| Last Update Date | 12/13/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194230086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 102382 (California) | Primary |
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