Healthcare Provider Details

I. General information

NPI: 1821367392
Provider Name (Legal Business Name): LANA ROSE YOUNG CAADE II/CATC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 D ST STE G
MARYSVILLE CA
95901-5957
US

IV. Provider business mailing address

201 D ST STE G
MARYSVILLE CA
95901-5957
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-2010
  • Fax: 707-462-6994
Mailing address:
  • Phone: 650-817-9070
  • Fax: 650-246-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: