=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346430287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATIONAL COUNCIL ON ALCOHOLISM AND OTHER DRUG ADDICTIONS BAY AREA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 11/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 944 MARKET ST 3RD FLOOR
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-296-9900
-----------------------------------------------------
Fax | 415-296-0626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 MARKET ST 3RD FLOOR
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-296-9900
-----------------------------------------------------
Fax | 415-296-0626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ANDREW DIEDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-296-9047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 38-005-01-100
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------