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MR. MAXWELL JACKSON ANTOR

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1922292218

Individual Registrant:
MR. MAXWELL JACKSON ANTOR 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4175 LAKESIDE DR #110 RICHMOND, CA 94806-5774 US
Tel: 510-262-6551  Fax: --

Contact information for business:
600 32ND ST #2 OAKLAND, CA 94609-2978 US
Tel: 415-710-2617  Fax: --

Registration Information:
NPI: 1922292218
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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