Provider Demographics
NPI:1093217325
Name:ALVAREZ, MONIC ADELLE (8788-R)
Entity Type:Individual
Prefix:
First Name:MONIC
Middle Name:ADELLE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:8788-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S HALCYON RD SPC 19
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-6256
Mailing Address - Country:US
Mailing Address - Phone:805-245-6325
Mailing Address - Fax:
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-332-4568
Practice Address - Fax:805-332-3487
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8788-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)