Provider Demographics
NPI:1639546120
Name:JJIREH LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:JJIREH LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:COUNSELING AND MORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LETTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-640-4179
Mailing Address - Street 1:4600 S TRACY BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8105
Mailing Address - Country:US
Mailing Address - Phone:209-640-4179
Mailing Address - Fax:209-207-9225
Practice Address - Street 1:4600 S TRACY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8105
Practice Address - Country:US
Practice Address - Phone:209-640-4179
Practice Address - Fax:209-207-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24606251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health