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Stephen R Colestock Jr.

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Blythe, CA

NPI 1750150058 · NPPES record last updated Jan 1, 2024

Key facts

NPI
1750150058
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
Practice address
9826 18TH Ave
Blythe, CA 92225-9229
Phone
(760) 922-8625
NPI assigned
Dec 27, 2023
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Veterans Alcohol Rehabilitation Program, Inc.-Varp, Inc. Current
since Dec 31, 2023		 Accepting new patients

Locations

9826 18th Ave
Blythe, CA 92225
Phone (760) 550-4684

1100 N D St
San Bernardino, CA 92410
Phone (909) 884-0840

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Yes

Addresses

Primary practice location

9826 18TH Ave
Blythe, CA 92225-9229

Mailing address

1100 N D St
San Bernardino, CA 92410-3524
Phone (760) 886-5003

Other providers in Blythe, CA

All providers in Blythe, CA · Addiction (Substance Use Disorder) Counselor in California

Sources for this page

Verify at the official NPI Registry.