Healthcare Provider Details

I. General information

NPI: 1699334615
Provider Name (Legal Business Name): RACHEL K KOLB CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

IV. Provider business mailing address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-2770
  • Fax: 626-792-5826
Mailing address:
  • Phone: 626-792-2770
  • Fax: 626-792-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC11921214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: