Healthcare Provider Details

I. General information

NPI: 1811565229
Provider Name (Legal Business Name): CELESTE LISA WHELAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 06/12/2021
Certification Date: 06/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GOUGH ST
SAN FRANCISCO CA
94102-5903
US

IV. Provider business mailing address

3950 23RD ST
SAN FRANCISCO CA
94114-3303
US

V. Phone/Fax

Practice location:
  • Phone: 415-240-2831
  • Fax: 415-864-2086
Mailing address:
  • Phone: 415-650-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: