Provider Demographics
NPI:1720597792
Name:WOODSFORD, RONALD CHARLES JR (CADC - I)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CHARLES
Last Name:WOODSFORD
Suffix:JR
Gender:M
Credentials:CADC - I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1333
Mailing Address - Country:US
Mailing Address - Phone:916-288-5267
Mailing Address - Fax:
Practice Address - Street 1:12183 LOCKSLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2050
Practice Address - Country:US
Practice Address - Phone:530-885-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI29650520101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)