Provider Demographics
NPI:1073328712
Name:WESTBROOKS, OMAR S
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:S
Last Name:WESTBROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 ALAMEDA ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3303
Mailing Address - Country:US
Mailing Address - Phone:510-616-8225
Mailing Address - Fax:
Practice Address - Street 1:2060 CHALLENGER DR STE 200
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1037
Practice Address - Country:US
Practice Address - Phone:510-337-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15895101YA0400X
CA4236E30E12171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)