Healthcare Provider Details

I. General information

NPI: 1881287449
Provider Name (Legal Business Name): ANNA MARIE MEADOWS RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 W OLIVE AVE
FRESNO CA
93728-2449
US

IV. Provider business mailing address

1106 N FRUIT AVE
FRESNO CA
93728-2923
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-5096
  • Fax: 800-337-7303
Mailing address:
  • Phone: 559-558-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: