Healthcare Provider Details

I. General information

NPI: 1285830992
Provider Name (Legal Business Name): COLUSA COUNTY DEPARTMENT OF SUBSTANCE ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E CARSON ST
COLUSA CA
95932-2866
US

IV. Provider business mailing address

162 E CARSON ST
COLUSA CA
95932-2866
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-0520
  • Fax:
Mailing address:
  • Phone: 530-458-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JACK EDWIN JOINER
Title or Position: DEPUTY DIRECTOR
Credential: MFT
Phone: 530-458-0824