Provider Demographics
NPI:1235353905
Name:HERRICK, CONSTANCE COLTON (LAC, DIPL OM)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:COLTON
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 GREENBANK AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4335
Mailing Address - Country:US
Mailing Address - Phone:510-652-7090
Mailing Address - Fax:510-652-3429
Practice Address - Street 1:147 GREENBANK AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-4335
Practice Address - Country:US
Practice Address - Phone:510-652-7090
Practice Address - Fax:510-652-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist