Provider Demographics
NPI:1821878646
Name:MCCONNAUGHY, RICKY ERICK
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:ERICK
Last Name:MCCONNAUGHY
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 1:501 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5439
Mailing Address - Country:US
Mailing Address - Phone:707-828-7274
Mailing Address - Fax:
Practice Address - Street 1:2158 SOLANO WAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4700
Practice Address - Country:US
Practice Address - Phone:925-690-5710
Practice Address - Fax:925-690-5711
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)