Healthcare Provider Details

I. General information

NPI: 1245767516
Provider Name (Legal Business Name): CHEMICAL DEPENDENCY TREATMENT ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 UNIVERSITY AVE STE 320
SACRAMENTO CA
95825-6580
US

IV. Provider business mailing address

455 UNIVERSITY AVE STE 320
SACRAMENTO CA
95825-6580
US

V. Phone/Fax

Practice location:
  • Phone: 916-333-5955
  • Fax:
Mailing address:
  • Phone: 916-333-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number2012239
License Number StateCA

VIII. Authorized Official

Name: ANGELLA BARR
Title or Position: PRESIDENT
Credential: MD
Phone: 917-301-5917