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Individual

ANGIE Y. MAIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1031 WATERLOO RD, STOCKTON, CA 95205-4256
(209) 940-5662
Mailing address
1031 WATERLOO RD, STOCKTON, CA 95205-4256
(209) 940-5662

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
00306046
CA
1041C0700X
Clinical Social Worker
Primary
00306046
CA

Other

Enumeration date
04/04/2014
Last updated
12/13/2023
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