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General NPI Number Information
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NPI Number | 1831237015
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Entity Type | Organization
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Legal Business Name | REDWOOD COMMUNITY SERVICES, INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 631 S ORCHARD AVE
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City | UKIAH
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State | CA
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Zip | 95482-5011
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Country | US
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Telephone | 707-472-2922
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Fax | 707-462-5172
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Provider Business Mailing Address
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Address Line | PO BOX 2077 631 S. ORCHARD ST.
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City | UKIAH
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State | CA
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Zip | 95482-2077
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Country | US
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Telephone | 707-467-2010
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Fax | 707-462-6994
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. VICTORIA JERUSHA KELLY
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Credential | LCSW
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Telephone | 707-467-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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Taxonomy #6
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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Taxonomy #7
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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Taxonomy #8
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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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Taxonomy #9
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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Taxonomy #10
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #11
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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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