Organization
WAVELENGTHS RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN BOYD (CEO)
(714) 642-2404
Entity
Organization
Contact information
Practice address
6 PETALUMA BLVD N STE A7, PETALUMA, CA 94952-3027
(714) 312-1011
Mailing address
301 MAIN ST STE 201, HUNTINGTON BEACH, CA 92648-5171
(714) 312-1011
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
225C00000X
Rehabilitation Counselor
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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