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General NPI Number Information
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NPI Number | 1992486443
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Entity Type | Organization
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Legal Business Name | CRESCENDO BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | WAYNE R. WILSON 70 WEST TERRACE ST
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City | ALTA DENA
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State | CA
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Zip | 91001
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Country | US
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Telephone | 707-797-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 736 BRIDGE ST UNIT 11
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City | VERNONIA
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State | OR
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Zip | 97064-1285
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Country | US
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Telephone | 707-797-0064
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | WAYNE DOC R. WILSON
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Credential | LCSW
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Telephone | 707-797-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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