Provider Demographics
NPI:1275720914
Name:STECKDAUB, MICHAEL ERNEST (RASI, CAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ERNEST
Last Name:STECKDAUB
Suffix:
Gender:M
Credentials:RASI, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42225 REMINGTON AVE.
Mailing Address - Street 2:SUITE 18
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2563
Mailing Address - Country:US
Mailing Address - Phone:951-587-4286
Mailing Address - Fax:951-587-4192
Practice Address - Street 1:42225 REMINGTON AVE.
Practice Address - Street 2:SUITE 18
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2563
Practice Address - Country:US
Practice Address - Phone:951-587-4286
Practice Address - Fax:951-587-4192
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-S0605041436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)