Healthcare Provider Details

I. General information

NPI: 1124755376
Provider Name (Legal Business Name): IAN ANDERSON CADC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31111 AGOURA RD STE 250
WESTLAKE VILLAGE CA
91361-4448
US

IV. Provider business mailing address

31111 AGOURA RD STE 250
WESTLAKE VILLAGE CA
91361-4448
US

V. Phone/Fax

Practice location:
  • Phone: 844-930-4434
  • Fax:
Mailing address:
  • Phone: 818-390-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI34251121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: