| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 256 24th St, Richmond, California |
| Authorized Official Name and Position | Patrick M. Godley (COO / CFO) |
| Authorized Official Contact | 9259575405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
50 Douglas Dr Suite 391 Martinez CA 94553-4098 Ph: () - | 256 24th St Richmond CA 94804-1804 Ph: (925) 957-5429 |
| NPI Number | 1952489270 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952489270 | NPI | - | NPPES |
| 0778 | Other | CA | MENTAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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