Provider Demographics
NPI:1740796564
Name:COWICK, MICHAEL CRAIG (CADC-CAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CRAIG
Last Name:COWICK
Suffix:
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:COWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-CAS
Mailing Address - Street 1:8633 KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3852
Mailing Address - Country:US
Mailing Address - Phone:714-527-6561
Mailing Address - Fax:
Practice Address - Street 1:12531 HARBOR BLVD STE G
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5824
Practice Address - Country:US
Practice Address - Phone:714-638-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23961214103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)