Healthcare Provider Details

I. General information

NPI: 1215488234
Provider Name (Legal Business Name): HARRISON STEWART CATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

PO BOX 1109
MARTINEZ CA
94553-0110
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2080
  • Fax: 707-425-4014
Mailing address:
  • Phone: 925-646-9270
  • Fax: 925-646-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCATC 168783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: