Healthcare Provider Details

I. General information

NPI: 1174798144
Provider Name (Legal Business Name): ALIDA VANSEENUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W GABILAN ST
SALINAS CA
93901
US

IV. Provider business mailing address

130 W GABILAN ST
SALINAS CA
93901-2762
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-0181
  • Fax:
Mailing address:
  • Phone: 831-758-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberV1002121416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: