Basic Information
| Provider Information | |||||||||
| NPI: | 1548479686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN LUIS OBISPO COUNTY DRUG AND ALCOHOL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3556 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934222532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054616080 | ||||||||
| FaxNumber: | 8054616114 | ||||||||
| Practice Location | |||||||||
| Address1: | 3556 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934222532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054616080 | ||||||||
| FaxNumber: | 8054616114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROEHM | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | DRUG AND ALCOHOL SPECIALIST II | ||||||||
| AuthorizedOfficialTelephone: | 8054616158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW, RAS#RO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.