Healthcare Provider Details

I. General information

NPI: 1871447045
Provider Name (Legal Business Name): BEN WILLIE AMEY III SUDCC IV, ASW100859
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SUNDALE AVE
BAKERSFIELD CA
93309-7908
US

IV. Provider business mailing address

5801 SUNDALE AVE
BAKERSFIELD CA
93309-7908
US

V. Phone/Fax

Practice location:
  • Phone: 661-827-3100
  • Fax:
Mailing address:
  • Phone: 661-747-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: