Healthcare Provider Details

I. General information

NPI: 1881802874
Provider Name (Legal Business Name): LOYD WOLFE JUVENILE JUSTICE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 FIRST STREET
NAPA CA
94559
US

IV. Provider business mailing address

2310 FIRST STREET
NAPA CA
94559
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 NumberCLR333500
License Number StateCA

VIII. Authorized Official

Name: MRS. SHEILA DAUGHERTY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-255-1855