Provider Demographics
NPI:1851654073
Name:BIRD, PATRICIA R (CADC LL CCS LAADC NR)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:R
Last Name:BIRD
Suffix:
Gender:F
Credentials:CADC LL CCS LAADC NR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W HOSPITALITY LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0026
Mailing Address - Country:US
Mailing Address - Phone:909-382-3127
Mailing Address - Fax:
Practice Address - Street 1:268 W HOSPITALITY LN
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0026
Practice Address - Country:US
Practice Address - Phone:909-382-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA037643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)