Provider Demographics
NPI:1649566225
Name:THE CENTER FOR THE TREATMENT OF ADDICTION
Entity Type:Organization
Organization Name:THE CENTER FOR THE TREATMENT OF ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:714-992-1677
Mailing Address - Street 1:104 N RAYMOND AVE
Mailing Address - Street 2:A-2
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4603
Mailing Address - Country:US
Mailing Address - Phone:714-992-1677
Mailing Address - Fax:
Practice Address - Street 1:104 N. RAYMOND AVE.
Practice Address - Street 2:A-2
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-992-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55017305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization