Provider Demographics
NPI:1093208209
Name:WARD, JOE ANTHONY (CAODC #8006)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ANTHONY
Last Name:WARD
Suffix:
Gender:M
Credentials:CAODC #8006
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 N MCCLELLAND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-1914
Mailing Address - Country:US
Mailing Address - Phone:805-245-7939
Mailing Address - Fax:
Practice Address - Street 1:113 S M ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6620
Practice Address - Country:US
Practice Address - Phone:805-736-0357
Practice Address - Fax:800-969-9350
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)