Healthcare Provider Details

I. General information

NPI: 1235310350
Provider Name (Legal Business Name): WOODLEAF EATING DISORDER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANKLIN ST SUITE #205
SAN FRANCISCO CA
94102-6017
US

IV. Provider business mailing address

45 FRANKLIN ST SUITE #205
SAN FRANCISCO CA
94102-6017
US

V. Phone/Fax

Practice location:
  • Phone: 415-840-0670
  • Fax: 415-664-5635
Mailing address:
  • Phone: 415-840-0670
  • Fax: 415-664-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45267
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number962411
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44272
License Number StateCA

VIII. Authorized Official

Name: APRIL ANNE VANCELETTE
Title or Position: CLINICAL DIRECTOR
Credential: MFT, M.S.
Phone: 415-287-4060