Individual
BENITA JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2323 BROADWAY, OAKLAND, CA 94612-2414
(415) 580-0090
Mailing address
2323 BROADWAY, OAKLAND, CA 94612-2414
(415) 580-0090
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00
AC BHCS CLINICIAN 00
CA
Enumeration date
09/19/2013
Last updated
05/21/2018
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