Healthcare Provider Details

I. General information

NPI: 1558608919
Provider Name (Legal Business Name): WOODLEAF EATING DISORDER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANKLIN ST STE 205
SAN FRANCISCO CA
94102-6021
US

IV. Provider business mailing address

45 FRANKLIN ST STE 205
SAN FRANCISCO CA
94102-6021
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: APRIL VANCELETTE
Title or Position: CLINICAL DIRECTOR
Credential: MFT
Phone: 415-368-6720