Healthcare Provider Details

I. General information

NPI: 1609208339
Provider Name (Legal Business Name): MARIE ANN LUDWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST ST
NAPA CA
94559-2239
US

IV. Provider business mailing address

427 WAYNE AVE APT 2
OAKLAND CA
94606-1142
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-1855
  • Fax: 707-255-5621
Mailing address:
  • Phone: 707-255-1855
  • Fax: 707-255-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: