Provider Demographics
NPI:1851748065
Name:DURBIN, JOHN RICHARD (CADC II - CA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:DURBIN
Suffix:
Gender:M
Credentials:CADC II - CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 TRINITY RIVER DR APT 85
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2965
Mailing Address - Country:US
Mailing Address - Phone:916-213-5753
Mailing Address - Fax:916-453-2708
Practice Address - Street 1:3600 POWER INN RD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-453-2704
Practice Address - Fax:916-453-2708
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII8741214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)