Provider Demographics
NPI:1043480791
Name:CARR, DOUGLAS (CADC-I)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3238
Mailing Address - Country:US
Mailing Address - Phone:707-693-1733
Mailing Address - Fax:707-693-1705
Practice Address - Street 1:255 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3238
Practice Address - Country:US
Practice Address - Phone:707-693-1733
Practice Address - Fax:707-693-1705
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4003007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4836OtherDRUG MEDICAL