Provider Demographics
NPI:1891151015
Name:ANDERSON, JEFFREY (CADC-CS, ICCS, ICADC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CADC-CS, ICCS, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S PALM CANYON DR STE A202
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-7210
Mailing Address - Country:US
Mailing Address - Phone:760-892-4538
Mailing Address - Fax:760-318-0610
Practice Address - Street 1:555 S PALM CANYON DR STE A202
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7210
Practice Address - Country:US
Practice Address - Phone:760-892-4538
Practice Address - Fax:760-318-0610
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)