Healthcare Provider Details

I. General information

NPI: 1053451740
Provider Name (Legal Business Name): DANA MONIQUE OTIS CAARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SUNSET LN
ANTIOCH CA
94509-6101
US

IV. Provider business mailing address

3707 SUNSET LN
ANTIOCH CA
94509-6101
US

V. Phone/Fax

Practice location:
  • Phone: 925-522-0124
  • Fax: 925-522-0133
Mailing address:
  • Phone: 925-522-0124
  • Fax: 925-522-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number03-037293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: