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General NPI Number Information
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NPI Number | 1245918887
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Entity Type | Individual
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Provider Name | RICHARD LINCOLN DONALD V RADT
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Gender | Male
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 2460 MAIN ST
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City | MORRO BAY
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State | CA
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Zip | 93442-1552
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Country | US
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Telephone | 805-888-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 MAIN ST
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City | MORRO BAY
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State | CA
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Zip | 93442-1552
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Country | US
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Telephone | 805-888-9619
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0985
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9619
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License Number State | CA
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