Provider Demographics
NPI:1700115433
Name:AMOS, JOSEPH LESLIE
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LESLIE
Last Name:AMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SEQUOIA CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4986
Mailing Address - Country:US
Mailing Address - Phone:707-322-8295
Mailing Address - Fax:
Practice Address - Street 1:3024 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2588
Practice Address - Country:US
Practice Address - Phone:707-322-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARRW 2580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)