Provider Demographics
NPI:1891318762
Name:CLIFFORD, PATRICIA (CADC-I)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 KESWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5244
Mailing Address - Country:US
Mailing Address - Phone:916-410-5340
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3225
Practice Address - Country:US
Practice Address - Phone:169-273-3914
Practice Address - Fax:916-376-7467
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI28411019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI28411019OtherCCAPP