Organization
BUCKELEW PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATY SPENSE (SENIOR SITE MANAGER)
(415) 457-6964
Entity
Organization
Contact information
Practice address
900 5TH AVE, SAN RAFAEL, CA 94901-2959
(415) 457-6964
Mailing address
900 5TH AVE, SAN RAFAEL, CA 94901-2959
(415) 457-6964
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/09/2010
Last updated
09/09/2010
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