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Organization
REDWOOD COMMUNITY SERVICES, INC.
Active
Organization
REDWOOD COMMUNITY SERVICES, INC.
Active
Parent organization
REDWOOD COMMUNITY SERVICES, INC.
Other names
The Harbor on Main
Organization subpart
Yes
Provider details
NPI number
Legal business name
REDWOOD COMMUNITY SERVICES, INC.
Authorized official
MRS. VICTORIA JERUSHA KELLY LMFT (CHIEF EXECUTIVE OFFICER)
(707) 467-2010
Entity
Organization
Contact information
Practice address
150 S MAIN ST, LAKEPORT, CA 95453-5017
(707) 994-5486
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17CC
LAKE CO MH SITE #
CA
Enumeration date
01/27/2009
Last updated
02/12/2020
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