Provider Demographics
NPI:1669986626
Name:ANDRADE, LARRY EUGENE II (CADC II)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EUGENE
Last Name:ANDRADE
Suffix:II
Gender:M
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 1:120 W SCHOOL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4925
Mailing Address - Country:US
Mailing Address - Phone:559-625-4100
Mailing Address - Fax:559-625-1970
Practice Address - Street 1:120 W SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4925
Practice Address - Country:US
Practice Address - Phone:559-625-4100
Practice Address - Fax:559-625-1970
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1207930715101YA0400X
CAA059650421101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)