Provider Demographics
NPI:1467149112
Name:CROTEAU, SARA (CADC I)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:CROTEAU
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 1:10996 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-9729
Mailing Address - Country:US
Mailing Address - Phone:209-770-7982
Mailing Address - Fax:
Practice Address - Street 1:18670 CARTER ST
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9637
Practice Address - Country:US
Practice Address - Phone:209-928-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI31491120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)