Healthcare Provider Details

I. General information

NPI: 1194378026
Provider Name (Legal Business Name): DEBORAH GWYNNE SLOAN CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

IV. Provider business mailing address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

V. Phone/Fax

Practice location:
  • Phone: 951-690-9859
  • Fax: 951-715-5060
Mailing address:
  • Phone: 951-690-9859
  • Fax: 951-715-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI34151121
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCI34151121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: