Provider Demographics
NPI:1184758146
Name:BILICH, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BILICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CODDINGTOWN CTR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3537
Mailing Address - Country:US
Mailing Address - Phone:707-565-7649
Mailing Address - Fax:
Practice Address - Street 1:1300 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3537
Practice Address - Country:US
Practice Address - Phone:707-565-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4900301120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)