Organization
EVOLVE FAMILY THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONI LEA DICKSON GARCIA LMFT #102382 (CLINICIAN/COE)
(209) 603-2929
Entity
Organization
Contact information
Practice address
359 W 11TH ST STE A1, TRACY, CA 95376-3863
(209) 603-2929
Mailing address
3021 BALBOA DR, TRACY, CA 95376-1905
(209) 603-2929
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
102382
CA
Other
Enumeration date
12/13/2017
Last updated
12/13/2017
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