Healthcare Provider Details

I. General information

NPI: 1164559381
Provider Name (Legal Business Name): DAWN VERCELLI CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

1904 RICHLAND AVE
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-541-2121
  • Fax: 209-541-2083
Mailing address:
  • Phone: 209-541-2121
  • Fax: 209-541-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberV0412181609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: