Healthcare Provider Details

I. General information

NPI: 1174661284
Provider Name (Legal Business Name): REDWOOD COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S HUMBOLDT ST
WILLITS CA
95490-3509
US

IV. Provider business mailing address

PO BOX 2462
WILLITS CA
95490-2462
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-9900
  • Fax: 707-459-9904
Mailing address:
  • Phone: 707-459-9900
  • Fax: 707-459-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA JERUSHA KELLY
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 707-467-2010