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General NPI Number Information
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NPI Number | 1861558678
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Entity Type | Individual
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Provider Name | RICHARD ALLAN DIWALD RAS
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 991 PARALLEL DR
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City | LAKEPORT
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State | CA
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Zip | 95453-5720
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Country | US
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Telephone | 707-263-8162
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Fax | 707-263-9336
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Provider Business Mailing Address
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Address Line | 10719B RANCHERIA RD
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City | UPPER LAKE
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State | CA
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Zip | 95485-9572
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Country | US
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Telephone | 707-245-4624
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Fax | 707-275-8005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D0412282000
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License Number State | CA
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