Provider Demographics
NPI:1356464887
Name:STOCKTON, JIM M (PEER SUPPORT COUNS)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:M
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:PEER SUPPORT COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2918
Mailing Address - Country:US
Mailing Address - Phone:415-292-1500
Mailing Address - Fax:415-292-2030
Practice Address - Street 1:1700 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2918
Practice Address - Country:US
Practice Address - Phone:415-292-1500
Practice Address - Fax:415-292-2030
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
9654OtherSFGH INTERNAL USE ONLY
9654OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER