Individual
CLYDE CHILDRESS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1466 LINCOLN AVE, SAN RAFAEL, CA 94901-2021
(415) 457-3755
Mailing address
1466 LINCOLN AVE, SAN RAFAEL, CA 94901-2021
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C1106010028
CA
Other
Enumeration date
05/03/2016
Last updated
05/03/2016
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