Provider Demographics
NPI:1437270733
Name:SAN JOAQUIN COUNTY BEHAVIOR HEALTH SUBSTANCE ABUSE SERVICES
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY BEHAVIOR HEALTH SUBSTANCE ABUSE SERVICES
Other - Org Name:CHEMICAL DEPENDENCY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-3720
Mailing Address - Street 1:620 N AURORA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2276
Mailing Address - Country:US
Mailing Address - Phone:209-468-3823
Mailing Address - Fax:
Practice Address - Street 1:750 BIRCH CT
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8768
Practice Address - Country:US
Practice Address - Phone:209-745-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty