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2201 Tuolumne St Vallejo CA 94589-2524 | |
(707) 558-1457 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 2201 Tuolumne St, Vallejo, California |
Authorized Official Name and Position | Lori Blackburn (VICE PRESIDENT) |
Authorized Official Contact | 2099552322 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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7590 Shoreline Dr Stockton CA 95219-5455 Ph: (209) 955-2328 | 2201 Tuolumne St Vallejo CA 94589-2524 Ph: (707) 558-1457 |
NPI Number | 1265567671 |
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Provider Enumeration Date | 02/23/2007 |
Last Update Date | 06/25/2013 |
Identifier | Type | State | Issuer |
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1265567671 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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