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NPI Code Detail

MEDICARE: ALCOHOL DRUG AND MENTAL HEALTH

MEDICARE: ALCOHOL DRUG AND MENTAL HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1184702128
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALCOHOL DRUG AND MENTAL HEALTH
Provider Business Mailing Address
First Line : 1511 SAN MIGUELITO RD
Second Line :
City : LOMPOC
State : CA
Zip : 93436-9742
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 117 N B ST
Second Line :
City : LOMPOC
State : CA
Zip : 93436-6901
Country : US
Telephone Number : 805-737-6663
Fax Number :
Authorized Official
Title or Position : MENTAL HEALTH PRACTITIONER INTERN
Name : VICKI HINKENS
Credential :
Telephone Number : 805-737-6663
Provider Enumeration Date : 11/01/2006
Last Update Date : 06/13/2008

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Directions to “ALCOHOL DRUG AND MENTAL HEALTH ” Practice Location

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