Provider Demographics
NPI:1932406899
Name:LASSEN COUNTY CHILD SUPPORT
Entity type:Organization
Organization Name:LASSEN COUNTY CHILD SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOMAGNO-BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-251-2635
Mailing Address - Street 1:1400 CHESTNUT STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130
Mailing Address - Country:US
Mailing Address - Phone:530-251-8112
Mailing Address - Fax:530-251-5884
Practice Address - Street 1:1600 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3720
Practice Address - Country:US
Practice Address - Phone:530-251-2635
Practice Address - Fax:530-251-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty