Healthcare Provider Details

I. General information

NPI: 1477482487
Provider Name (Legal Business Name): MR. CHRISTOPHER DAVID WOOLSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 BROCKTON AVE
RIVERSIDE CA
92506-3821
US

IV. Provider business mailing address

4280 SIERRA AVE
NORCO CA
92860-1344
US

V. Phone/Fax

Practice location:
  • Phone: 951-234-9940
  • Fax:
Mailing address:
  • Phone: 562-326-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: