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620 N Aurora St Ste 7 Stockton CA 95202-2276 | |
| (209) 888-4519 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 620 N Aurora St Ste 7, Stockton, California |
| Authorized Official Name and Position | Geneva Haynes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2098884519 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
620 N Aurora St Ste 7 Stockton CA 95202-2276 Ph: (209) 888-4519 | 620 N Aurora St Ste 7 Stockton CA 95202-2276 Ph: (209) 888-4519 |
| NPI Number | 1093418048 |
|---|---|
| Provider Enumeration Date | 03/27/2023 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093418048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 163WC0400X | Registered Nurse - Case Management | (* (Not Available)) | Secondary |
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