Individual
DEMARCO MIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 N AURORA ST STE 1, STOCKTON, CA 95202-2276
(209) 468-9370
Mailing address
14895 E 14TH ST STE 465, SAN LEANDRO, CA 94578-2989
(510) 346-7100
(510) 346-7101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
CA
Other
Enumeration date
03/28/2018
Last updated
06/03/2025
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