MEDICARE: MR. CHRISTOPHER DAVID WOOLSEY

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	23034	CA

General Provider Information

NPI Number	:	1477482487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER DAVID WOOLSEY

Provider Business Mailing Address
First Line	:	4280 SIERRA AVE
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-1344
Country	:	US
Telephone Number	:	562-326-0733
Fax Number	:

Provider Business Practice Location Address
First Line	:	6860 BROCKTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3821
Country	:	US
Telephone Number	:	951-234-9940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	06/02/2026

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