| Victor Community Support Services, Stockton | |
|
2495 W March Ln Suite 125 (miocr Program) Stockton CA 95207-8251 | |
| (209) 465-1080 | |
| (209) 465-2709 |
| Full Name | Victor Community Support Services, Stockton |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2495 W March Ln, Stockton, California |
| Authorized Official Name and Position | Angie Wiechert (FINANCIAL ANALYST) |
| Authorized Official Contact | 5302301210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victor Community Support Services, Stockton 2561 California Park Dr Chico CA 95928-4166 Ph: (530) 893-0758 | Victor Community Support Services, Stockton 2495 W March Ln Suite 125 (miocr Program) Stockton CA 95207-8251 Ph: (209) 465-1080 |
| NPI Number | 1184814477 |
|---|---|
| Provider Enumeration Date | 08/01/2007 |
| Last Update Date | 12/20/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184814477 | NPI | - | NPPES |
| 01042 | Other | CA | LEGAL ENTITY # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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