Provider Demographics
NPI:1174023832
Name:KYRIAKAKOS, WILLIAM (CADC II A054100319)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KYRIAKAKOS
Suffix:
Gender:M
Credentials:CADC II A054100319
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 BIRCH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2228
Mailing Address - Country:US
Mailing Address - Phone:714-540-9070
Mailing Address - Fax:
Practice Address - Street 1:4120 BIRCH ST STE 121
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2228
Practice Address - Country:US
Practice Address - Phone:951-310-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054100319101YA0400X
CI07350417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)