Provider Demographics
NPI:1740841402
Name:RIDE THE WAVE RECOVERY: PROFESSIONAL CLINICAL COUNSELOR PC
Entity type:Organization
Organization Name:RIDE THE WAVE RECOVERY: PROFESSIONAL CLINICAL COUNSELOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:831-275-5481
Mailing Address - Street 1:104 WALNUT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3929
Mailing Address - Country:US
Mailing Address - Phone:831-275-5481
Mailing Address - Fax:
Practice Address - Street 1:104 WALNUT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3929
Practice Address - Country:US
Practice Address - Phone:831-275-5481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty