Organization
REDWOOD COMMUNITY SERVICES, INC
Active
Parent organization
REDWOOD COMMUNITY SERVICES, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
REDWOOD COMMUNITY SERVICES, INC.
Authorized official
MRS. VICTORIA JERUSHA KELLY LCSW (CHIEF EXECUTIVE OFFICER)
(707) 467-2010
Entity
Organization
Contact information
Practice address
154 S MAIN ST, LAKEPORT, CA 95453-5017
(707) 263-0372
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
(707) 467-2009
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171721
CALOMS #
CA
Enumeration date
04/13/2012
Last updated
12/10/2020
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