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1100 Rose Drive Suite 224 Benicia CA 94510-3608 | |
(707) 642-5139 | |
(707) 641-1104 |
Full Name | |
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Speciality | Marriage & Family Therapist |
Location | 1100 Rose Drive, Benicia, California |
Authorized Official Name and Position | Ollis Carver (CEO, SR. THERAPIST) |
Authorized Official Contact | 7076425139 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 6691 Vallejo CA 94591-1691 Ph: (707) 642-5139 | 1100 Rose Drive Suite 224 Benicia CA 94510-3608 Ph: (707) 642-5139 |
NPI Number | 1013655703 |
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Provider Enumeration Date | 05/23/2022 |
Last Update Date | 11/17/2023 |
Certification Date | 11/17/2023 |
Identifier | Type | State | Issuer |
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1013655703 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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