Provider Demographics
NPI:1457475733
Name:WITTERS, GERALD GEORGE (CADC1)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:GEORGE
Last Name:WITTERS
Suffix:
Gender:M
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 LENZEN AVE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2737
Mailing Address - Country:US
Mailing Address - Phone:408-792-5645
Mailing Address - Fax:408-947-8719
Practice Address - Street 1:976 LENZEN AVE
Practice Address - Street 2:1ST FLOOR, ROOM 12 DADS CASE MGT. TEAM
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2737
Practice Address - Country:US
Practice Address - Phone:408-792-5645
Practice Address - Fax:408-947-8719
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC10101113OtherCADC1
CARW4296OtherCALIFORNIA ASSOCIATION OF ALCOHOL & DRUG COUNSELORS- REGISTERED RECOVERY WORKER