Basic Information
| Provider Information | |||||||||
| NPI: | 1285830992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUSA COUNTY DEPARTMENT OF SUBSTANCE ABUSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 162 E CARSON ST | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 162 E CARSON ST | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOINER | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
| AuthorizedOfficialMiddleName: | EDWIN | ||||||||
| AuthorizedOfficialTitleorPosition: | DEPUTY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5304580824 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.