Basic Information
| Provider Information | |||||||||
| NPI: | 1093208209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | JOE | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | CAODC #8006 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1670 N MCCLELLAND ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934541914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052457939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 S M ST | ||||||||
| Address2: | |||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934366620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057360357 | ||||||||
| FaxNumber: | 8009699350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 8006 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.