Provider Demographics
NPI:1689220477
Name:FESSENDEN, CARL LEONARD (CADC-II)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:LEONARD
Last Name:FESSENDEN
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3618
Mailing Address - Country:US
Mailing Address - Phone:707-290-1166
Mailing Address - Fax:
Practice Address - Street 1:1974 WINCHESTER PL
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3618
Practice Address - Country:US
Practice Address - Phone:707-290-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker