Provider Demographics
NPI:1023573524
Name:AMADOR, LAURA A (CADC II)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:AMADOR
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5179 E DWIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5918
Mailing Address - Country:US
Mailing Address - Phone:559-475-4096
Mailing Address - Fax:
Practice Address - Street 1:2731 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2449
Practice Address - Country:US
Practice Address - Phone:559-233-5096
Practice Address - Fax:844-337-7303
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII057620518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)