Organization
ADMHS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LENNIE KWOCK LCSW (MANAGER)
(805) 884-1629
Entity
Organization
Contact information
Practice address
429 N SAN ANTONIO RD, SANTA BARBARA, CA 93110
(805) 884-1629
Mailing address
315 CAMINO DEL REMEDIO, SANTA BARBARA, CA 93110-1332
(805) 884-1628
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
N4473383
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N4473383
CALIFORNIA DRIVER LICENSE
CA
Enumeration date
09/26/2007
Last updated
09/26/2007
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