Provider Demographics
NPI:1568525954
Name:ACOLATSE, JULIET DARKO
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:DARKO
Last Name:ACOLATSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34704 STEARMAN CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-9359
Mailing Address - Country:US
Mailing Address - Phone:209-855-1006
Mailing Address - Fax:
Practice Address - Street 1:1201 N SUTTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1506
Practice Address - Country:US
Practice Address - Phone:209-855-1006
Practice Address - Fax:209-408-1160
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical