Healthcare Provider Details

I. General information

NPI: 1821383902
Provider Name (Legal Business Name): HELEN ELIZABETH PRENDERGASS CADC II, ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE A
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

130 S FIG ST
ESCONDIDO CA
92025-4401
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 760-685-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA022290316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: