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Organization
UNIVERSITY OF THE PACIFIC
Active
Organization
UNIVERSITY OF THE PACIFIC
Active
Other names
Martin Gipson Socialization Center
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY WHITE (EXECUTIVE DIRECTOR)
(209) 946-2132
Entity
Organization
Contact information
Practice address
405 E PINE ST, STOCKTON, CA 95204-5522
(209) 464-5519
Mailing address
3601 PACIFIC AVE, UOP PSYCHOLOGY DEPARTMENT, STOCKTON, CA 95211-0110
(209) 946-2132
(209) 946-2284
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90432
OTHER, 90432 CA
CA
01
—
90441
OTHER 90441 CA
CA
Enumeration date
01/06/2009
Last updated
11/13/2019
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