Provider Demographics
NPI:1205970266
Name:ZONA SECA YOUTH AND FAMILY TREATMENT CENTER
Entity type:Organization
Organization Name:ZONA SECA YOUTH AND FAMILY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVENING PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:BASW,RAS,NCAC 1
Authorized Official - Phone:805-740-9799
Mailing Address - Street 1:3486 MESA CIRCLE DRIVE
Mailing Address - Street 2:211
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-733-7517
Mailing Address - Fax:
Practice Address - Street 1:218 NORTH I ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-740-9799
Practice Address - Fax:805-740-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA014619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty