Healthcare Provider Details

I. General information

NPI: 1629479886
Provider Name (Legal Business Name): NICOLAS TOWNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 TENNESSEE ST
VALLEJO CA
94590-4453
US

IV. Provider business mailing address

408 TENNESSEE ST
VALLEJO CA
94590-4453
US

V. Phone/Fax

Practice location:
  • Phone: 707-554-2397
  • Fax:
Mailing address:
  • Phone:
  • 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: