Healthcare Provider Details

I. General information

NPI: 1124598644
Provider Name (Legal Business Name): KATE LIVINGOOD LAADAC, CADC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 ROSS LN
HUNTINGTN BCH CA
92647-5019
US

IV. Provider business mailing address

16712 ROSS LN
HUNTINGTN BCH CA
92647-5019
US

V. Phone/Fax

Practice location:
  • Phone: 194-935-5396
  • Fax:
Mailing address:
  • Phone: 194-935-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLNR1630411
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberLNR1630411
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberLRN1630411
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLNR1630411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: