Provider Demographics
NPI:1053449413
Name:PISTONE, NICK (CADC-II)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:PISTONE
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 RANCHEROS DR
Mailing Address - Street 2:SUITE 166
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2900
Mailing Address - Country:US
Mailing Address - Phone:760-744-3672
Mailing Address - Fax:760-744-6182
Practice Address - Street 1:340 RANCHEROS DR
Practice Address - Street 2:SUITE 166
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2900
Practice Address - Country:US
Practice Address - Phone:760-744-3672
Practice Address - Fax:760-744-6182
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8533505101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)