Health and Social Services

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

13718 Issued in CA

Legal business name

HEALTH AND SOCIAL SERVICES

Practice address

2101 Courage Dr
Fairfield, CA 94533-6717

Phone

(707) 784-2140

Fax

(707) 784-2164

NPI assigned

Dec 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Shannon F. Williamson, ASW

Title

Mental Health Clinician

Phone

(707) 784-2140

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295890945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2191 COX LN",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945338970",
            "telephone_number": "707-437-4960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 COURAGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336717",
            "telephone_number": "707-784-2140",
            "fax_number": "707-784-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH AND SOCIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "MENTAL HEALTH CLINICIAN",
        "authorized_official_telephone_number": "707-784-2140",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ASW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "13718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.