Healthcare Provider Details

I. General information

NPI: 1871778704
Provider Name (Legal Business Name): ROBERT WILLIAM GREEAR CADC II, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

5820 LEON AVE
MARYSVILLE CA
95901-6112
US

V. Phone/Fax

Practice location:
  • Phone: 916-370-5501
  • Fax:
Mailing address:
  • Phone: 916-370-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA020260815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: