Healthcare Provider Details

I. General information

NPI: 1821117672
Provider Name (Legal Business Name): ALTERNATIVE ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WAGON WHEEL RD
OXNARD CA
93036-1165
US

IV. Provider business mailing address

2575 WAGON WHEEL RD
OXNARD CA
93036-1165
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-1112
  • Fax: 805-988-4883
Mailing address:
  • Phone: 805-988-1112
  • Fax: 805-988-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01862
License Number StateCA

VIII. Authorized Official

Name: MS. MILLI ATLEE KELLY
Title or Position: CLINICAL DIRECTOR
Credential: MS
Phone: 805-988-1112