Healthcare Provider Details

I. General information

NPI: 1902104672
Provider Name (Legal Business Name): DANIELLE LANGFORD CADC-II-CA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE ANNE MASHBURN CAADE

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 09/23/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

6938 E CLINTON AVE
FRESNO CA
93727-1417
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-458-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII051040218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: