VICTOR COMMUNITY SUPPORT SERVICES, INC (NPI# 1184814477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184814477 |
| Entity Type | Organization |
| Organization Name | VICTOR COMMUNITY SUPPORT SERVICES, INC |
| Other Organization Name | VICTOR COMMUNITY SUPPORT SERVICES, STOCKTON |
| Practice Address |
2495 W March Ln Suite 125 (miocr Program) Stockton CA 95207-8251 |
| Mailing Address |
2561 California Park Dr Chico CA 95928-4166 |
| Practice Telephone | 2094651080 |
| Practice Fax Number | 2094652709 |
| Mailing Telephone | 5308930758 |
| Mailing Fax Number | 5308930502 |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-12-20 |
| Authorized Official Name | MRS. ANGIE WIECHERT (FINANCIAL ANALYST) |
| Authorized Official Telephone | 5302301210 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LEGAL ENTITY # | 01042 | 01 |
| Other Name | Type Code |
|---|---|
| Victor Community Support Services, Stockton | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003114810 | Victor Community Support Services, Inc | Clinic/Center | 1545 S Holt Rd, Stockton, CA 95206-9618 | 2011-03-02 |
| 1518207885 | Victor Community Support Services, Inc | Clinic/Center | 15400 Cholame Rd, Victorville, CA 92392-2480 | 2013-02-25 |
| 1184926495 | Victor Community Support Services, Inc | Clinic/Center | 222 E Main St, Suite 112, 113, 114, 115, 116, and 117, Barstow, CA 92311-2361 | 2010-11-19 |
| 1316127434 | Victor Community Support Services, Inc | Clinic/Center | 900 E Main St, Suite 201, Grass Valley, CA 95945-5853 | 2007-11-06 |
| 1558434126 | Victor Community Support Services, Inc | Community/Behavioral Health | 103 D St, Marysville, CA 95901-6017 | 2006-11-15 |
| Street Address |
2495 W MARCH LN SUITE 125 (MIOCR PROGRAM) |
| City | STOCKTON |
| State | CA |
| Zip Code | 95207-8251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083719553 | Rosanne Marie Christie | Marriage & Family Therapist | 2495 W March Ln, Suite 125, Stockton, CA 95207-8251 | 2006-09-13 |
| 1093337560 | Dynesha Rene Montoya | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2020-05-07 |
| 1013537661 | Karina Huerta | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2020-04-23 |
| 1679108989 | Willie Thompson | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2020-03-06 |
| 1831735497 | Christian Ivan Valerio Solis | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2019-11-19 |
| 1568004422 | Richardyovany Herrera | Social Worker | 2495 W March Ln, Stockton, CA 95207-8251 | 2019-10-11 |
| 1689221244 | Magali Gonzalez-mercado | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2019-08-19 |
| 1962068841 | Fernando Octavio De Alba | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2019-05-15 |
| 1447716758 | Dennis Jerome Johnson | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2019-02-12 |
| 1134698046 | Raymond Acosta | Counselor | 2495 W March Ln, Stockton, CA 95207-8251 | 2018-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669004438 | Dr. Jeffrey A Saladin, Dental Corporation | Dentist | 1002 Robinhood Drive, Stockton, CA 95207 | 2020-02-10 |
| 1811533110 | Tanya V Jones | Dental Hygienist | Community Medical Centers, 83 W. March Ln., Stockton, CA 95207 | 2019-11-21 |
| 1053966358 | Ingrid Marcela Saavedra | Behavioral Analyst | 1545 Saint Marks Plaza Ste 9, Stockton, CA 95207 | 2019-08-05 |
| 1497218861 | Turning Point Community Programs | Community/Behavioral Health | 1803 W March Ln Ste C-d, Stockton, CA 95207 | 2019-04-11 |
| 1427510627 | Stockton Sleep Center Inc | Physiological Laboratory | 1545 Saint Marks Plaza, Suite 2, Stockton, CA 95207 | 2019-04-05 |
| 1518436229 | Nicolas Anthony Overby | Occupational Therapist | Windsor Elmhaven Care Cente 6940 Pacific Ave, Stockton, CA 95207 | 2018-11-26 |
| 1912475724 | Ashley Johnson | Behavior Technician | 87 W. March Ln. Suite 6, Stockton, CA 95207 | 2018-11-09 |
| 1124596085 | Korie Cottrell | Behavior Technician | 87 W. March Ln., Suite 6, Stockton, CA 95207 | 2018-11-08 |
| 1760979645 | Maria Esther Rodriguez | Counselor | 2425 W March Ln., Stockton, CA 95207 | 2018-04-17 |
| 1902301161 | Lashray Elliott | Behavior Technician | 2291 W. Mach Lane, Ste C101, Stockton, CA 95207 | 2018-03-28 |
| Find all providers in zip 95207 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003114810 | Victor Community Support Services, Inc | Clinic/Center | 1545 S Holt Rd, Stockton, CA 95206-9618 | 2011-03-02 |
| 1609085984 | San Joaquin County Behavioral Health Services | Clinic/Center | 6776 Alexandria Pl, Stockton, CA 95207-3407 | 2007-05-22 |
| 1477762334 | San Joaquin County Behavioral Health Services | Clinic/Center | 333 E Washington St, Stockton, CA 95202-3200 | 2007-05-21 |
| 1629285903 | San Joaquin County Behavioral Health Services | Clinic/Center | 1414 N California St, Stockton, CA 95202-1515 | 2007-05-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.