Provider Demographics
NPI:1982236717
Name:SCHANK, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SCHANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3707
Mailing Address - Country:US
Mailing Address - Phone:510-236-3139
Mailing Address - Fax:510-236-3200
Practice Address - Street 1:1901 CHURCH LN
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3707
Practice Address - Country:US
Practice Address - Phone:510-236-3139
Practice Address - Fax:510-236-3200
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)