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Organization
REDWOOD COMMUNITY SERVICES, INC
Active
Organization
REDWOOD COMMUNITY SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA JERUSHA KELLY LCSW (CHIEF EXECUTIVE OFFICER)
(707) 467-2010
Entity
Organization
Contact information
Practice address
631 S ORCHARD AVE, UKIAH, CA 95482-5011
(707) 472-2922
(707) 462-5172
Mailing address
PO BOX 2077, 631 S. ORCHARD ST., UKIAH, CA 95482-2077
(707) 467-2010
(707) 462-6994
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TR0400X
Rehabilitation Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
—
—
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01418707
—
CA
05
—
01863308
—
CA
01
—
12AA
HUMBOLDT CO PROVIDER NO
CA
01
—
2392
MENDOCINO CO MH SITE #
CA
01
—
49EE1
SONOMA CO PROVIDER NO
CA
Enumeration date
02/01/2007
Last updated
01/21/2020
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