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General NPI Number Information
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NPI Number | 1124305347
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Entity Type | Individual
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Provider Name | CLINTON W. ALDRICH CADC
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Gender | Male
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 89 HOMER DR
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City | ST MARIES
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State | ID
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Zip | 83861-5078
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Country | US
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Telephone | 208-245-5427
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Fax | 209-245-5425
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Provider Business Mailing Address
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Address Line | 89 HOMER DR
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City | ST MARIES
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State | ID
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Zip | 83861-5078
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Country | US
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Telephone | 208-245-5427
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Fax | 209-245-5425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10045
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License Number State | ID
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