Provider Demographics
NPI:1851783948
Name:ZUMWALT CADC-1, CCJP, NANETTE (CADC-1, CCJP)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:
Last Name:ZUMWALT CADC-1, CCJP
Suffix:
Gender:F
Credentials:CADC-1, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21062 BROOKHURST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7404
Mailing Address - Country:US
Mailing Address - Phone:714-964-6730
Mailing Address - Fax:714-964-4382
Practice Address - Street 1:21062 BROOKHURST ST STE 202
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7404
Practice Address - Country:US
Practice Address - Phone:714-964-6730
Practice Address - Fax:714-964-4382
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2001306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25847OtherIICB
CAC2001306OtherCAADAC
CACJP1300109OtherCCBADC