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General NPI Number Information
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NPI Number | 1093497620
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Entity Type | Individual
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Provider Name | GEORGE ALFRED ROENSCH JR. CADC I
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Gender | Male
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 2751 NAPA VALLEY CORPORATE DR
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City | NAPA
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State | CA
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Zip | 94558-6216
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Country | US
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Telephone | 707-287-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 703 SARATOGA DR APT 221
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City | NAPA
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State | CA
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Zip | 94559-3593
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Country | US
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Telephone | 707-287-3744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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