Provider Demographics
NPI:1639042419
Name:RADIANT FOCUS THERAPY A LICENSED CLINICAL SOCIAL WORKERS CORPORATION
Entity type:Organization
Organization Name:RADIANT FOCUS THERAPY A LICENSED CLINICAL SOCIAL WORKERS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-627-5944
Mailing Address - Street 1:1533 SHADOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-5277
Mailing Address - Country:US
Mailing Address - Phone:209-627-5944
Mailing Address - Fax:
Practice Address - Street 1:1533 SHADOWOOD CT
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-5277
Practice Address - Country:US
Practice Address - Phone:209-627-5944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty