Provider Demographics
NPI:1952169054
Name:STOCKTON, JIRINA (APCC15931)
Entity Type:Individual
Prefix:
First Name:JIRINA
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:APCC15931
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W LANCASTER BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2303
Mailing Address - Country:US
Mailing Address - Phone:661-903-8822
Mailing Address - Fax:
Practice Address - Street 1:815 W LANCASTER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2303
Practice Address - Country:US
Practice Address - Phone:661-903-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC15931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health