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General NPI Number Information
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NPI Number | 1912123944
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ COMMUNITY COUNSELING CENTER
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 640 RODRIGUEZ ST
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City | WATSONVILLE
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State | CA
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Zip | 95076-4212
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Country | US
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Telephone | 831-722-2471
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Fax |
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Provider Business Mailing Address
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Address Line | 195 HARVEY WEST BLVD
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2126
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Country | US
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Telephone | 831-469-1700
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Fax | 831-425-1905
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PAUL O'BRIEN
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Credential |
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Telephone | 831-469-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 440001DN
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License Number State | CA
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