Healthcare Provider Details

I. General information

NPI: 1417421298
Provider Name (Legal Business Name): JOINT VENTURE CENTRAL COAST ADDICTION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 SHELL BEACH RD STE 102
SHELL BEACH CA
93449-1930
US

IV. Provider business mailing address

1677 SHELL BEACH RD STE 102
SHELL BEACH CA
93449-1930
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-7180
  • Fax:
Mailing address:
  • Phone: 805-416-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA APODACA
Title or Position: PRESIDENT
Credential:
Phone: 805-440-3284