Healthcare Provider Details

I. General information

NPI: 1689457186
Provider Name (Legal Business Name): KATHLEEN RICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 6TH ST
SANTA ANA CA
92703-2101
US

IV. Provider business mailing address

1225 W 6TH ST
SANTA ANA CA
92703-2101
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-1402
  • Fax: 714-972-1519
Mailing address:
  • Phone: 714-503-6816
  • Fax: 657-216-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA067120925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: