Healthcare Provider Details

I. General information

NPI: 1972789972
Provider Name (Legal Business Name): MONIQUE MARIE MCMORRIS CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 23RD ST
RICHMOND CA
94804-1830
US

IV. Provider business mailing address

4610 WALL AVE
RICHMOND CA
94804-3460
US

V. Phone/Fax

Practice location:
  • Phone: 510-216-4601
  • Fax: 510-680-0346
Mailing address:
  • Phone: 510-860-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC13001214
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: