Basic Information
| Provider Information | |||||||||
| NPI: | 1083953517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORLAND | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | RASI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16248 VICTOR ST. | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602437151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16248 VICTOR ST | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923953934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602437151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2013 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RI-W1210221054 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.