Healthcare Provider Details

I. General information

NPI: 1780217901
Provider Name (Legal Business Name): JAMES MERKEL CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 W RAMSEY ST STE 3&4
BANNING CA
92220-3700
US

IV. Provider business mailing address

2781 W RAMSEY ST STE 3&4
BANNING CA
92220-3700
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-6612
  • Fax: 951-524-0016
Mailing address:
  • Phone: 951-417-6612
  • Fax: 951-524-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA055011123
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI34700122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: