Provider Demographics
NPI:1104450303
Name:RICHARDSON, JAMES ALAN (CADC II, ICADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:CADC II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 N MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2741
Mailing Address - Country:US
Mailing Address - Phone:408-885-1003
Mailing Address - Fax:408-885-1024
Practice Address - Street 1:264 N MORRISON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2741
Practice Address - Country:US
Practice Address - Phone:408-885-1003
Practice Address - Fax:408-885-1024
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1331461218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)