Terra Renne Wilson, SAC II
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Lower Lake, CA
NPI 1821134271 · NPPES record last updated Aug 21, 2009
Key facts
- NPI
- 1821134271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- RI-G0505091545 (CA)
- Practice address
- 9345 Winchester
Lower Lake, CA 95457 - Phone
- (707) 995-3235
- Fax
- (707) 995-7004
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RI-G0505091545 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | RI-G0505091545 | CA | Yes |
Addresses
Primary practice location
9345 Winchester
Lower Lake, CA 95457
Mailing address
9345 Winchester
Lower Lake, CA 95457-5720
Phone (707) 995-3235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RI-G0505091545 | Other | CA | SUBSTANCE ABUSE DISORDER |
Other names
- Terra Renne Goodrich
Other providers in Lower Lake, CA
- Karla Marie Vliet
- Ronald Raymond Walker
- Wendy E Weiss
- Western Health Resources
- Elina Filippova Wickersham
All providers in Lower Lake, CA · Addiction (Substance Use Disorder) Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.