Provider Demographics
NPI:1346422672
Name:SOUSA, CONCEPCION LEONA (PPSC, REGISTERED ASW)
Entity Type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:LEONA
Last Name:SOUSA
Suffix:
Gender:F
Credentials:PPSC, REGISTERED ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540
Mailing Address - Country:US
Mailing Address - Phone:707-682-9331
Mailing Address - Fax:
Practice Address - Street 1:2145 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-296-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical