Provider Demographics
NPI:1639839038
Name:CAULBOY, ADRIAN LOUIS
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LOUIS
Last Name:CAULBOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7931
Mailing Address - Country:US
Mailing Address - Phone:925-825-1769
Mailing Address - Fax:
Practice Address - Street 1:555 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3937
Practice Address - Country:US
Practice Address - Phone:925-432-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes172V00000XOther Service ProvidersCommunity Health Worker