Healthcare Provider Details

I. General information

NPI: 1215159991
Provider Name (Legal Business Name): SEXUAL ASSAULT & DOMESTIC VIOLENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 COURT STREET
WOODLAND CA
95695
US

IV. Provider business mailing address

933 COURT STREET
WOODLAND CA
95695
US

V. Phone/Fax

Practice location:
  • Phone: 530-661-6336
  • Fax: 530-661-3021
Mailing address:
  • Phone: 530-661-6336
  • Fax: 530-661-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMFC33208
License Number StateCA

VIII. Authorized Official

Name: MS. JUDITH A. TISCHER
Title or Position: DIRECTOR OF COUNSELING
Credential: LMFC
Phone: 530-661-6336