Rashard O Stallworth | Stockton, CA • PECOS Search

Rashard O Stallworth

Counselor

Behavioral Health & Social Service Providers

1212 N California St, Stockton, CA 95202-1552

(209) 468-0102 (209) 468-2337

PECOS Enrollment

Based on the most recent information from CMS, provider Rashard O Stallworth does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1417124231
Provider Type
Individual
Full Name
Stallworth, Rashard O
Title
Mr.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
5/12/2008
Last Updated
2/19/2021

Contact Information

Practice Location

1212 N California St, Stockton, CA 95202-1552

Unlisted Fax

Mailing Location

1149 N. California Street, Stockton, CA 95202

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer