Provider Demographics
NPI:1881171155
Name:COLTEN, C DIANE (CADC I)
Entity type:Individual
Prefix:
First Name:C DIANE
Middle Name:
Last Name:COLTEN
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:DIANE
Other - Last Name:COLTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 OAKCREST CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8727
Mailing Address - Country:US
Mailing Address - Phone:714-883-5653
Mailing Address - Fax:
Practice Address - Street 1:3659 PEDLEY AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1597
Practice Address - Country:US
Practice Address - Phone:951-283-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI23910518101YA0400X
CA071405101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)