Healthcare Provider Details

I. General information

NPI: 1104672922
Provider Name (Legal Business Name): DAVID CARL OVERTON C059110818
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 COHASSET RD STE 130
CHICO CA
95973-5403
US

IV. Provider business mailing address

3211 COHASSET RD STE 130
CHICO CA
95973-5403
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-4610
  • Fax: 530-879-3823
Mailing address:
  • Phone: 530-552-4610
  • Fax: 530-879-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC059110818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: