Provider Demographics
NPI:1891189403
Name:VALLEY COMMUNITY COUSELING SERVICES
Entity Type:Organization
Organization Name:VALLEY COMMUNITY COUSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOF
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:RASI
Authorized Official - Phone:209-334-2126
Mailing Address - Street 1:1300 W LODI AVE STE G2
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3037
Mailing Address - Country:US
Mailing Address - Phone:209-334-2126
Mailing Address - Fax:209-369-8406
Practice Address - Street 1:1300 W. LODI STE G-2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-2126
Practice Address - Fax:209-369-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management