Provider Demographics
NPI:1902646649
Name:KING-MCCARTHY, THERESA (PPSC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KING-MCCARTHY
Suffix:
Gender:F
Credentials:PPSC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPSC
Mailing Address - Street 1:5758 W LAS POSITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4083
Mailing Address - Country:US
Mailing Address - Phone:925-596-4670
Mailing Address - Fax:
Practice Address - Street 1:5758 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4083
Practice Address - Country:US
Practice Address - Phone:925-596-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool