Provider Demographics
NPI:1558608919
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:
Authorized Official - Last Name:VANCELETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-368-6720
Mailing Address - Street 1:45 FRANKLIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6021
Mailing Address - Country:US
Mailing Address - Phone:415-840-0670
Mailing Address - Fax:
Practice Address - Street 1:45 FRANKLIN ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6021
Practice Address - Country:US
Practice Address - Phone:415-840-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty