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Individual
MICHAEL B CONNOLLY
Active
Individual
MICHAEL B CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC II
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
179638
CA
172V00000X
Community Health Worker
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
179638
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AII31410819
CCAPP
CA
Enumeration date
01/09/2018
Last updated
06/04/2024
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