Provider Demographics
NPI:1376057182
Name:NORTH COAST SUBSTANCE ABUSE COUNCIL
Entity Type:Organization
Organization Name:NORTH COAST SUBSTANCE ABUSE COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-445-0869
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-1332
Mailing Address - Country:US
Mailing Address - Phone:707-445-0869
Mailing Address - Fax:707-445-0826
Practice Address - Street 1:1205 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1224
Practice Address - Country:US
Practice Address - Phone:707-445-0869
Practice Address - Fax:707-445-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120005AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty