Provider Demographics
NPI:1326386400
Name:BETTENCOURT, DONNA CHRISTINE (CAS I)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:CHRISTINE
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:CAS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 KEITH ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2910
Mailing Address - Country:US
Mailing Address - Phone:559-583-7800
Mailing Address - Fax:559-583-7890
Practice Address - Street 1:222 KEITH ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2910
Practice Address - Country:US
Practice Address - Phone:559-583-7800
Practice Address - Fax:559-583-7890
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02067214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)