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Clyde Childress JR.
Counselor in San Rafael, California
NPI 1376998898

Clyde Childress JR. is a Counselor based in San Rafael, CA. Clyde Childress JR. practices in San Rafael, CA. The NPI Number for Clyde Childress JR. is 1376998898 and holds a License No. C1106010028 (California).

The current practice location address for Clyde Childress JR. is 1466 Lincoln Ave, San Rafael, CA and can be reached out via phone at 415-457-3755.

Location: 1466 Lincoln Ave, San Rafael, CA, 94901-2021
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1376998898
Provider Name
Clyde Childress JR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
1466 Lincoln Ave, San Rafael, CA, 94901-2021
Phone Number
415-457-3755
Fax Number
Provider Enumeration Date
05/03/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1466 Lincoln Ave
City
San Rafael
State
California
Zip
94901-2021
Phone Number
415-457-3755
Fax Number
person
Provider Business Mailing Address Details
Address
1466 Lincoln Ave
City
San Rafael
State
California
Zip
94901-2021
Phone Number
415-457-3755
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
C1106010028 (California)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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