Provider Demographics
NPI:1811010267
Name:VALLEY COMMUNITY COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:VALLEY COMMUNITY COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-472-6443
Mailing Address - Street 1:129 E CENTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4648
Mailing Address - Country:US
Mailing Address - Phone:209-239-5553
Mailing Address - Fax:209-239-5978
Practice Address - Street 1:129 E CENTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4648
Practice Address - Country:US
Practice Address - Phone:209-239-5553
Practice Address - Fax:209-239-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health