Provider Demographics
NPI:1881176873
Name:PRECOURT, CHARLES KEVIN (CADC I)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KEVIN
Last Name:PRECOURT
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23041 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4236
Mailing Address - Country:US
Mailing Address - Phone:888-416-2046
Mailing Address - Fax:
Practice Address - Street 1:23041 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4236
Practice Address - Country:US
Practice Address - Phone:888-416-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI13800518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)