Healthcare Provider Details

I. General information

NPI: 1750689915
Provider Name (Legal Business Name): COUNCIL ON ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E CANON PERDIDO ST
SANTA BARBARA CA
93101-2242
US

IV. Provider business mailing address

232 E CANON PERDIDO ST
SANTA BARBARA CA
93101-2242
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-1433
  • Fax: 805-963-4099
Mailing address:
  • Phone: 805-963-1433
  • Fax: 805-963-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1501
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1501
License Number StateCA

VIII. Authorized Official

Name: MR. WIM VERKAIK
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 805-963-1433