Provider Demographics
NPI:1770886327
Name:VICTOR COMMUNITY SUPPORT SERVICES REDDING
Entity type:Organization
Organization Name:VICTOR COMMUNITY SUPPORT SERVICES REDDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGS
Authorized Official - Suffix:
Authorized Official - Credentials:MFTI
Authorized Official - Phone:530-223-2822
Mailing Address - Street 1:3300 CHURN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002
Mailing Address - Country:US
Mailing Address - Phone:530-223-2822
Mailing Address - Fax:530-223-1917
Practice Address - Street 1:3300 CHURN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-223-2822
Practice Address - Fax:530-223-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty