MEDICARE: THERESA DOSS CADC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1841636446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA DOSS CADC II

Provider Business Mailing Address
First Line	:	PO BOX 25040
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92406-0640
Country	:	US
Telephone Number	:	909-886-2994
Fax Number	:	909-886-0218

Provider Business Practice Location Address
First Line	:	2164 MOUNTIAN VIEW AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405
Country	:	US
Telephone Number	:	909-886-2994
Fax Number	:	909-886-0218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	02/05/2026

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