Provider Demographics
NPI:1538815808
Name:ROCK LIFE COUNSELING, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:ROCK LIFE COUNSELING, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-728-0866
Mailing Address - Street 1:2150 N 1ST ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2020
Mailing Address - Country:US
Mailing Address - Phone:408-728-0866
Mailing Address - Fax:
Practice Address - Street 1:2150 N 1ST ST FL 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2020
Practice Address - Country:US
Practice Address - Phone:408-728-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health