Provider Demographics
NPI:1114379054
Name:WARD, ROXANNE (6539-R)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:6539-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DAVI AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3701
Mailing Address - Country:US
Mailing Address - Phone:925-427-1384
Mailing Address - Fax:925-427-4127
Practice Address - Street 1:2 DAVI AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3701
Practice Address - Country:US
Practice Address - Phone:925-427-1384
Practice Address - Fax:925-427-4127
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6536-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR0699196OtherCDL