Provider Demographics
NPI:1730960253
Name:KOKORO COUNSELING CENTER, INC., A LICENSED CLINICAL SOCIAL WORKER
Entity type:Organization
Organization Name:KOKORO COUNSELING CENTER, INC., A LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-592-6939
Mailing Address - Street 1:1692 MANGROVE AVE PMB 136
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2648
Mailing Address - Country:US
Mailing Address - Phone:530-592-6939
Mailing Address - Fax:530-231-6380
Practice Address - Street 1:341 BROADWAY ST STE 223
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5355
Practice Address - Country:US
Practice Address - Phone:530-433-9745
Practice Address - Fax:530-231-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty