Provider Demographics
NPI:1255687919
Name:EMILIA D. SANTUCCI, FAMILY THERAPIST, A PROFESSIONAL ORGANIZATION
Entity Type:Organization
Organization Name:EMILIA D. SANTUCCI, FAMILY THERAPIST, A PROFESSIONAL ORGANIZATION
Other - Org Name:CENTRAL VALLEY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-605-2591
Mailing Address - Street 1:203 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3048
Mailing Address - Country:US
Mailing Address - Phone:209-845-9037
Mailing Address - Fax:209-322-3291
Practice Address - Street 1:203 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3048
Practice Address - Country:US
Practice Address - Phone:209-845-9037
Practice Address - Fax:209-322-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty