Provider Demographics
NPI:1841964400
Name:CORE PURPOSE THERAPY, LICENSED CLINICAL SOCIAL WORKER, PC
Entity type:Organization
Organization Name:CORE PURPOSE THERAPY, LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LANKFORD
Authorized Official - Last Name:HOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-342-7485
Mailing Address - Street 1:1401 21ST ST STE R
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:858-342-7485
Mailing Address - Fax:
Practice Address - Street 1:1401 21ST ST STE R
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:619-880-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64860OtherLCSW