Healthcare Provider Details

I. General information

NPI: 1801922182
Provider Name (Legal Business Name): LARRY WAYNE COLBERT CADC-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E OCEAN AVE
LOMPOC CA
93436-6829
US

IV. Provider business mailing address

1100 UNION AVE
BAKERSFIELD CA
93307-1051
US

V. Phone/Fax

Practice location:
  • Phone: 805-849-2318
  • Fax: 805-849-2318
Mailing address:
  • Phone: 661-861-6111
  • Fax: 661-861-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA04150315
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: