Provider Demographics
NPI:1659732097
Name:CONTRERAS, DANIEL EZEKIEL (CADC-CAS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EZEKIEL
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:DANNY
Other - Middle Name:
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC-CAS
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061
Mailing Address - Country:US
Mailing Address - Phone:831-454-4100
Mailing Address - Fax:831-454-4296
Practice Address - Street 1:1080 EMELINE BUILDING D
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-454-4100
Practice Address - Fax:831-454-4296
Is Sole Proprietor?:No
Enumeration Date:2016-03-13
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC035390815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)