Provider Demographics
NPI:1669254744
Name:SHIRK, STEVEN ANTHONY (16464-RAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:SHIRK
Suffix:
Gender:M
Credentials:16464-RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W COMMONWEALTH AVE # 2144
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3019
Mailing Address - Country:US
Mailing Address - Phone:951-772-6211
Mailing Address - Fax:
Practice Address - Street 1:2100 W COMMONWEALTH AVE # 2144
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3019
Practice Address - Country:US
Practice Address - Phone:951-772-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16464-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)