Healthcare Provider Details

I. General information

NPI: 1831424209
Provider Name (Legal Business Name): CLIVE STEWART CADC II, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SUN STREET
SALINAS CA
93901
US

IV. Provider business mailing address

11 PEACH DR
SALINAS CA
93901-3710
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5135
  • Fax:
Mailing address:
  • Phone: 831-753-6001
  • Fax: 831-753-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA015390315
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: