Healthcare Provider Details

I. General information

NPI: 1932229630
Provider Name (Legal Business Name): PDAP OF VENTURA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10738 ENCINO DR
OAK VIEW CA
93022-9238
US

IV. Provider business mailing address

10738 ENCINO DR
OAK VIEW CA
93022-9238
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-4939
  • Fax:
Mailing address:
  • Phone: 805-233-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number040970
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA A WALLACE
Title or Position: COUNSELOR
Credential: CATC, CAMF
Phone: 805-482-1265