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Organization
SHARE HOMES
Active
Organization
SHARE HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM BEREAN LMFT (EXECUTIVE DIRECTOR)
(209) 327-0588
Entity
Organization
Contact information
Practice address
210 N SCHOOL ST, LODI, CA 95240-2122
(209) 334-6376
Mailing address
210 N SCHOOL ST, LODI, CA 95240-2122
(209) 334-6376
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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