Healthcare Provider Details

I. General information

NPI: 1750778874
Provider Name (Legal Business Name): FABRICE DOLCE CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN ST SUITE 409
KLAMATH FALLS OR
97601-5831
US

IV. Provider business mailing address

905 MAIN ST SUITE 409
KLAMATH FALLS OR
97601-5831
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-6004
  • Fax: 541-273-0813
Mailing address:
  • Phone: 541-884-6004
  • Fax: 541-273-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11-12-78
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: