Healthcare Provider Details

I. General information

NPI: 1619636842
Provider Name (Legal Business Name): DUSTIN HAYES KESSLER AMFT, CADC-III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DUSTY WHITEWATER

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

2178 ABBOTT ST APT 2
SAN DIEGO CA
92107-2056
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax:
Mailing address:
  • Phone: 760-688-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBII00310720
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: