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General NPI Number Information
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NPI Number | 1841471943
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Entity Type | Organization
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Legal Business Name | SAN LUI OBISPO CENTER FOR CHANGE
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 285 SOUTH ST SUITE M
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-5037
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Country | US
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Telephone | 805-544-2892
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Fax | 805-544-2887
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Provider Business Mailing Address
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Address Line | 285 SOUTH ST SUITE M
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-5037
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Country | US
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Telephone | 805-544-2892
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Fax | 805-544-2887
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Authorized Official
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Title or Position | ADMIN ASSENT
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Name | MRS. STEPHANIE LYNN MORGAN
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Credential |
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Telephone | 805-544-2892
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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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