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General NPI Number Information
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NPI Number | 1851952972
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Entity Type | Individual
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Provider Name | CHARLES RANDOLPH WINDER CADC II, RAS II
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Gender | Male
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 850 E FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376-5230
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Country | US
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Telephone | 909-421-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 7796 LEUCITE AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-2724
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Country | US
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Telephone | 909-693-0591
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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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