Provider Demographics
NPI:1205535820
Name:MCCALL, ARCHIE III (RADT)
Entity type:Individual
Prefix:
First Name:ARCHIE
Middle Name:
Last Name:MCCALL
Suffix:III
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6310
Mailing Address - Country:US
Mailing Address - Phone:707-443-4237
Mailing Address - Fax:
Practice Address - Street 1:1303 11TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2028
Practice Address - Country:US
Practice Address - Phone:707-444-6262
Practice Address - Fax:707-442-1191
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073023107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073023107OtherNPI