Provider Demographics
NPI:1093966111
Name:FELICIANO, ALVIN (CADC II, ILSAC, CCS)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:CADC II, ILSAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 NEW SALEM ST UNIT 19
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2317
Mailing Address - Country:US
Mailing Address - Phone:619-804-9618
Mailing Address - Fax:858-635-6690
Practice Address - Street 1:8452 NEW SALEM ST UNIT 19
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2317
Practice Address - Country:US
Practice Address - Phone:619-804-9618
Practice Address - Fax:858-635-6690
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)