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General NPI Number Information
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NPI Number | 1437585791
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Entity Type | Organization
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Legal Business Name | READY4CHANGE
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 3400 WATT AVE SUITE #205
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City | SACRAMENTO
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State | CA
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Zip | 95821-3602
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Country | US
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Telephone | 916-821-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 WATT AVE SUITE #205
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City | SACRAMENTO
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State | CA
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Zip | 95821-3602
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Country | US
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Telephone | 916-821-9090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. LEO ANTHONY VASQUEZ I
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Credential | B.S.W, RAS 11
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Telephone | 916-821-9090
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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 |
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