Provider Demographics
NPI:1568732519
Name:ROSS, JOSEPH LEONARD (CAS NAADAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEONARD
Last Name:ROSS
Suffix:
Gender:M
Credentials:CAS NAADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0848
Mailing Address - Country:US
Mailing Address - Phone:530-226-1742
Mailing Address - Fax:530-224-2723
Practice Address - Street 1:1441 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0848
Practice Address - Country:US
Practice Address - Phone:530-226-1742
Practice Address - Fax:530-224-2723
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03073137101YA0400X
CA015398101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03-073137OtherCERTIFIED ADDICTION SPECIALIST
CA015398OtherNATIONAL CERTIFIED ADDICTIONS COUNSELOR