Provider Demographics
NPI:1295042182
Name:MS BEV ADDICTION COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:MS BEV ADDICTION COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCI2361214
Authorized Official - Phone:510-569-9555
Mailing Address - Street 1:PO BOX 18665
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-0665
Mailing Address - Country:US
Mailing Address - Phone:510-569-9555
Mailing Address - Fax:510-569-9555
Practice Address - Street 1:6020 OLD QUARRY LOOP
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3306
Practice Address - Country:US
Practice Address - Phone:510-569-9555
Practice Address - Fax:510-569-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-068218251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management