Healthcare Provider Details

I. General information

NPI: 1720597792
Provider Name (Legal Business Name): RONALD CHARLES WOODSFORD JR. CADC - I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN STE 101
AUBURN CA
95602-2050
US

IV. Provider business mailing address

7360 SANDALWOOD DR
CITRUS HEIGHTS CA
95621-1333
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1961
  • Fax:
Mailing address:
  • Phone: 916-288-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI29650520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: