Provider Demographics
NPI:1376389403
Name:OLMOS, CELESTE M
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:M
Last Name:OLMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:OLMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUD
Mailing Address - Street 1:2 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1430
Mailing Address - Country:US
Mailing Address - Phone:510-660-4171
Mailing Address - Fax:
Practice Address - Street 1:208 23RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1830
Practice Address - Country:US
Practice Address - Phone:510-660-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)