Provider Demographics
NPI:1750689915
Name:COUNCIL ON ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:COUNCIL ON ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:WIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VERKAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-963-1433
Mailing Address - Street 1:232 E CANON PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2242
Mailing Address - Country:US
Mailing Address - Phone:805-963-1433
Mailing Address - Fax:805-963-4099
Practice Address - Street 1:232 E CANON PERDIDO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2242
Practice Address - Country:US
Practice Address - Phone:805-963-1433
Practice Address - Fax:805-963-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1501101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty