Provider Demographics
NPI:1235340878
Name:COUNTY OF SAN LUIS OBISPO DRUG AND ALCOHOL SERVICES
Entity Type:Organization
Organization Name:COUNTY OF SAN LUIS OBISPO DRUG AND ALCOHOL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:805-781-4759
Mailing Address - Street 1:2180 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4558
Mailing Address - Country:US
Mailing Address - Phone:805-781-4275
Mailing Address - Fax:805-781-1227
Practice Address - Street 1:3556 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-461-6080
Practice Address - Fax:805-461-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400003BN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center