Doctor Name: | MICHAEL ANDRADE |
NPI Number: | 1336290485 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | RI-A0612181235 |
Business Practice Address: | 7000-b South Center Dr Clearlake, CA - 95422 |
Business Phone Number: | 7079946494 |
Business Fax Number: | |
Mailing Address: | Po Box 1560, CLEARLAKE |
State: | CA |
Postal Code: | 95422 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | RI-A0612181235 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |