| Candice Diane Peterson, | |
| 
					902 Tuolumne St, Vallejo, CA 94590-4641  | |
| (707) 648-8121 | |
| Not Available | 
| Full Name | Candice Diane Peterson | 
|---|---|
| Gender | Female | 
| Speciality | Counselor - Mental Health | 
| Location | 902 Tuolumne St, Vallejo, California | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1992956379 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary | 
| Entity Name | Mood Clinical, P. C. | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1922675644 PECOS PAC ID: 4981080769 Enrollment ID: O20220930002640  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Candice Diane Peterson, 1972 Maybelle Dr, Pleasant Hill, CA 94523-2708 Ph: (925) 798-7191  | Candice Diane Peterson, 902 Tuolumne St, Vallejo, CA 94590-4641 Ph: (707) 648-8121  | 
Leata Jeames,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 2201 Tuolumne St, Vallejo, CA 94589 Phone: 707-558-1777 Fax: 707-558-1770  | |
Ned L Jacobs,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 1017 Tennessee St, Vallejo, CA 94590 Phone: 707-647-1520  | |
Tiffany Marie Tyler,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 908 Tuolumne St, Vallejo, CA 94590 Phone: 707-648-8121 Fax: 707-648-8129  | |
Michelle Reneta Ortiz,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 126 Ohio St, Vallejo, CA 94590 Phone: 415-707-2577 Fax: 707-644-5501  | |
Tanesha Nixon,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 627 Grant St, Vallejo, CA 94590 Phone: 707-553-1042  | |
Debra Marrama, PROGRAM DIRECTOR Counselor Medicare: Not Enrolled in Medicare Practice Location: 3467 Edgewater Pl, Vallejo, CA 94591 Phone: 707-732-8105 Fax: 707-667-0010  | |
Mr. Bjay Jones,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 236 Georgia Street, Vallejo, CA 94590 Phone: 510-229-2786  |