Healthcare Provider Details

I. General information

NPI: 1093208209
Provider Name (Legal Business Name): JOE ANTHONY WARD CAODC #8006
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S M ST
LOMPOC CA
93436-6620
US

IV. Provider business mailing address

1670 N MCCLELLAND ST
SANTA MARIA CA
93454-1914
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-0357
  • Fax: 800-969-9350
Mailing address:
  • Phone: 805-245-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8006
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: