Healthcare Provider Details

I. General information

NPI: 1568650729
Provider Name (Legal Business Name): SANTA CRUZ COMMUNITY COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 HIGHWAY 9
FELTON CA
95018-9718
US

IV. Provider business mailing address

709 MISSION ST
SANTA CRUZ CA
95060-3614
US

V. Phone/Fax

Practice location:
  • Phone: 831-335-6300
  • Fax:
Mailing address:
  • Phone:
  • 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: CAROL PRUITT
Title or Position: PROGRAM MANAGER
Credential:
Phone: 831-429-8350