Provider Demographics
NPI:1861641300
Name:UDI, JOSEPH EFFIONG (CAADAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EFFIONG
Last Name:UDI
Suffix:
Gender:M
Credentials:CAADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N BULLIS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1652
Mailing Address - Country:US
Mailing Address - Phone:310-635-8822
Mailing Address - Fax:310-635-8828
Practice Address - Street 1:1315 N BULLIS RD STE 8
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1652
Practice Address - Country:US
Practice Address - Phone:310-635-8822
Practice Address - Fax:310-635-8828
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS4064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)