Organization
LINCOLN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALLISON STAULCUP BECWAR LCSW (CHIEF PROGRAM OFFICER)
(510) 273-4700
Entity
Organization
Contact information
Practice address
8755 FONTAINE ST, OAKLAND, CA 94605-4141
(510) 639-3244
(510) 639-3246
Mailing address
150 LINDEN ST, OAKLAND, CA 94607-2538
(510) 852-0133
(510) 530-8083
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000054BM
MEDI-CAL PROVIDER NUMBER
—
Enumeration date
06/17/2014
Last updated
11/12/2024
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