Provider Demographics
NPI:1467776211
Name:EVERETTE, AL JOE (CADC-II, SAP)
Entity Type:Individual
Prefix:MR
First Name:AL
Middle Name:JOE
Last Name:EVERETTE
Suffix:
Gender:M
Credentials:CADC-II, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4930
Mailing Address - Country:US
Mailing Address - Phone:559-924-0658
Mailing Address - Fax:559-584-5944
Practice Address - Street 1:5339 N FRESNO ST. SUITE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6851
Practice Address - Country:US
Practice Address - Phone:559-309-0124
Practice Address - Fax:559-584-5944
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA817394101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)