Individual
ANTHONY AADOLPHUS LORD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1140 ELM DR APT 3, NOVATO, CA 94945-3133
(415) 320-2489
(415) 492-0834
Mailing address
1140 ELM DR APT 3, NOVATO, CA 94945-3133
(415) 320-2489
(415) 492-0834
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
MPSS-CAZSPQ
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N5836204
—
CA
Enumeration date
05/19/2017
Last updated
08/04/2025
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