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General NPI Number Information
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NPI Number | 1124661038
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Entity Type | Individual
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Provider Name | MR. DEWAYNE PATTERSON SR.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 69730 HIGHWAY 111 STE 109
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2873
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Country | US
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Telephone | 760-322-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 67740 QUIJO RD
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-5541
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Country | US
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Telephone | 760-218-2934
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6766
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License Number State | CA
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