Provider Demographics
NPI:1407167117
Name:VARGAS, PRESTON (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 NAPA ST UNIT 3023
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5686
Mailing Address - Country:US
Mailing Address - Phone:415-340-2564
Mailing Address - Fax:
Practice Address - Street 1:3051 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2523
Practice Address - Country:US
Practice Address - Phone:415-340-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC057660618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)