Basic Information
| Provider Information | |||||||||
| NPI: | 1255587960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLELLA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CAADE/AOD INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 353 | ||||||||
| Address2: | |||||||||
| City: | EL GRANADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940180353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507263149 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 225 CABRILLO HWY S | ||||||||
| Address2: | #200A | ||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940198200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507266369 | ||||||||
| FaxNumber: | 6507264963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.