Provider Demographics
NPI:1073378592
Name:LLOYD, JAMIE D (CADC II)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:LLOYD
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 1:19331 SUSAN WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9209
Mailing Address - Country:US
Mailing Address - Phone:209-770-3159
Mailing Address - Fax:
Practice Address - Street 1:19331 SUSAN WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9209
Practice Address - Country:US
Practice Address - Phone:209-770-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052570921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)