Healthcare Provider Details

I. General information

NPI: 1912332420
Provider Name (Legal Business Name): JUDY ALEXANDER CADC II, ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E LAKE AVE
WATSONVILLE CA
95076-4424
US

IV. Provider business mailing address

90 GREAT OAKS BLVD
SAN JOSE CA
95119-1314
US

V. Phone/Fax

Practice location:
  • Phone: 317-286-4458
  • Fax:
Mailing address:
  • Phone: 408-281-0708
  • Fax: 408-281-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: