Healthcare Provider Details

I. General information

NPI: 1942347133
Provider Name (Legal Business Name): JUSTIN PEWITT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 HARTNELL AVE
REDDING CA
96002-2113
US

IV. Provider business mailing address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-7213
  • Fax:
Mailing address:
  • Phone: 805-965-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1576130824
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: