Provider Demographics
NPI:1235310350
Name:WOODLEAF EATING DISORDER CENTER
Entity Type:Organization
Organization Name:WOODLEAF EATING DISORDER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VANCELETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, MS
Authorized Official - Phone:415-287-4060
Mailing Address - Street 1:45 FRANKLIN ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6017
Mailing Address - Country:US
Mailing Address - Phone:415-840-0670
Mailing Address - Fax:415-664-5635
Practice Address - Street 1:45 FRANKLIN ST
Practice Address - Street 2:SUITE #205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6017
Practice Address - Country:US
Practice Address - Phone:415-840-0670
Practice Address - Fax:415-664-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44272106H00000X
CA45267106H00000X
CA962411133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty