Healthcare Provider Details

I. General information

NPI: 1851987242
Provider Name (Legal Business Name): BRANDON DAVID CAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 05/10/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 3RD ST
LINCOLN CA
95648-1562
US

IV. Provider business mailing address

1530 3RD ST
LINCOLN CA
95648-1562
US

V. Phone/Fax

Practice location:
  • Phone: 916-434-8927
  • Fax:
Mailing address:
  • Phone: 916-434-8927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: