Organization
SUPPORTING SOCIAL SUCCESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK BANNON MS (DIRECTOR)
(510) 493-0855
Entity
Organization
Contact information
Practice address
6116 CHELTON DR, OAKLAND, CA 94611-2429
(510) 493-0855
Mailing address
6116 CHELTON DR, OAKLAND, CA 94611-2429
(510) 493-0855
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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