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General NPI Number Information
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NPI Number | 1114808136
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Entity Type | Organization
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Legal Business Name | CAROLYN'S PLACE
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 1822 SUTTER ST
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City | VALLEJO
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State | CA
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Zip | 94590-4429
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Country | US
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Telephone | 707-563-8709
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Fax | 916-357-9993
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Provider Business Mailing Address
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Address Line | 1822 SUTTER ST
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City | VALLEJO
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State | CA
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Zip | 94590-4429
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Country | US
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Telephone | 707-563-8709
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Fax | 916-357-9993
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Authorized Official
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Title or Position | FOUNDER
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Name | TERRI D RAIFORD
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Credential | CADC II
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Telephone | 707-246-2728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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