Provider Demographics
NPI:1164779898
Name:DEICHLER, DAVID WAYNE (SUDCCII, CSC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:DEICHLER
Suffix:
Gender:M
Credentials:SUDCCII, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 CONNORS CT STE C
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1175
Mailing Address - Country:US
Mailing Address - Phone:530-898-9424
Mailing Address - Fax:530-898-0239
Practice Address - Street 1:392 CONNORS CT STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1175
Practice Address - Country:US
Practice Address - Phone:530-898-9424
Practice Address - Fax:530-898-0239
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD0710311220101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9195OtherSUBSTANCE USE DISORDER CERTIFIED COUNSELOR II
CAD0710311220OtherCLINICAL SUPERVISOR CREDENTIAL