Individual
CHAD NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 N ANAHEIM BLVD, ANAHEIM, CA 92805-2652
(714) 776-7490
Mailing address
707 N ANAHEIM BLVD, ANAHEIM, CA 92805-2652
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/17/2016
Last updated
11/17/2016
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