Provider Demographics
NPI:1851969059
Name:NORTH STATE SOCIAL WORK & PSYCHOTHERAPY SERVICES INC A LICEN
Entity Type:Organization
Organization Name:NORTH STATE SOCIAL WORK & PSYCHOTHERAPY SERVICES INC A LICEN
Other - Org Name:NORTH STATE SWAPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-638-2067
Mailing Address - Street 1:859 WASHINGTON ST # 203
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2704
Mailing Address - Country:US
Mailing Address - Phone:530-638-2067
Mailing Address - Fax:949-561-5392
Practice Address - Street 1:1135 PINE ST STE 21
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0750
Practice Address - Country:US
Practice Address - Phone:530-638-2067
Practice Address - Fax:949-561-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty