Provider Demographics
NPI:1346823309
Name:FORWARD ETHOS COUNSELING, PC
Entity Type:Organization
Organization Name:FORWARD ETHOS COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTEPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCISQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-382-2733
Mailing Address - Street 1:1266 TRACY CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8585
Mailing Address - Country:US
Mailing Address - Phone:515-777-6059
Mailing Address - Fax:
Practice Address - Street 1:2940 SUMMIT ST STE 2C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:916-382-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)