Provider Demographics
NPI:1407512189
Name:WATERMAN, MEGAN LEANN (CADC - I)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEANN
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:CADC - I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 MCFARLAN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1348
Mailing Address - Country:US
Mailing Address - Phone:707-499-8452
Mailing Address - Fax:
Practice Address - Street 1:1205 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1224
Practice Address - Country:US
Practice Address - Phone:707-445-0869
Practice Address - Fax:707-445-0826
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2113295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)