Provider Demographics
NPI:1790282028
Name:MAYZE, YOLANDA (RADT-1)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MAYZE
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-1685
Mailing Address - Country:US
Mailing Address - Phone:530-668-9627
Mailing Address - Fax:530-668-8528
Practice Address - Street 1:15450 COUNTY ROAD 99
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-9339
Practice Address - Country:US
Practice Address - Phone:530-668-9627
Practice Address - Fax:530-668-8528
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1286051217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)