Healthcare Provider Details

I. General information

NPI: 1427172899
Provider Name (Legal Business Name): DEBBIE DIANE BECKETT CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N NORMA ST STE 127-133
RIDGECREST CA
93555-2575
US

IV. Provider business mailing address

1400 N. NORMA STREET SUITE 127-133
RIDGECREST CA
93555
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-7406
  • Fax: 760-499-9259
Mailing address:
  • Phone: 760-499-7406
  • Fax: 760-499-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA02270315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: