Individual
ALEX WISHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
380 ENCINAL ST STE 200, SANTA CRUZ, CA 95060-2178
(831) 469-1700
(831) 425-1905
Mailing address
380 ENCINAL ST STE 200, SANTA CRUZ, CA 95060-2178
(831) 469-1700
(831) 425-1905
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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