Provider Demographics
NPI:1205090719
Name:CENTRAL COAST EATING DISORDER PROGRAM SERVICES AND WORKSHOP
Entity type:Organization
Organization Name:CENTRAL COAST EATING DISORDER PROGRAM SERVICES AND WORKSHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-688-5656
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-0835
Mailing Address - Country:US
Mailing Address - Phone:805-688-5057
Mailing Address - Fax:
Practice Address - Street 1:1851 SHELL BEACH RD
Practice Address - Street 2:
Practice Address - City:SHELL BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-1860
Practice Address - Country:US
Practice Address - Phone:805-688-5057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health