Provider Demographics
NPI:1326288523
Name:VISCONTI, MIKE PAUL (RAS, CCDS)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:PAUL
Last Name:VISCONTI
Suffix:
Gender:M
Credentials:RAS, CCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LANDING CR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-893-3698
Mailing Address - Fax:530-893-3748
Practice Address - Street 1:4133 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-893-3698
Practice Address - Fax:530-893-3748
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-V0811190900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)