Provider Demographics
NPI:1932229630
Name:PDAP OF VENTURA COUNTY
Entity Type:Organization
Organization Name:PDAP OF VENTURA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:CATC, CAMF
Authorized Official - Phone:805-482-1265
Mailing Address - Street 1:10738 ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-9238
Mailing Address - Country:US
Mailing Address - Phone:805-233-4939
Mailing Address - Fax:
Practice Address - Street 1:10738 ENCINO DR
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9238
Practice Address - Country:US
Practice Address - Phone:805-233-4939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040970OtherCOUNSELOR