Provider Demographics
NPI:1508439720
Name:CULTURAL CONNECTION THERAPY CENTER
Entity Type:Organization
Organization Name:CULTURAL CONNECTION THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOGUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-416-1710
Mailing Address - Street 1:719 2ND ST STE 8
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4666
Mailing Address - Country:US
Mailing Address - Phone:530-505-1994
Mailing Address - Fax:530-231-0128
Practice Address - Street 1:719 2ND ST STE 8
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4666
Practice Address - Country:US
Practice Address - Phone:530-505-1994
Practice Address - Fax:530-231-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)