Provider Demographics
NPI:1659825545
Name:ECKER, COLLEEN (CADAC-II, CCDP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:ECKER
Suffix:
Gender:F
Credentials:CADAC-II, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 S ELENA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 S ELENA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5703
Practice Address - Country:US
Practice Address - Phone:310-874-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA022670316101YA0400X
CACDP0301113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health