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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |