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General NPI Number Information
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NPI Number | 1912441387
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Entity Type | Individual
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Provider Name | VICTORIA CALLAWAY BAASCH RADTI
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Gender | Female
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2844 COLOMA ST
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City | PLACERVILLE
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State | CA
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Zip | 95667-4406
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Country | US
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Telephone | 530-626-9240
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Fax | 530-626-8992
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Provider Business Mailing Address
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Address Line | 2640 CAMBRIDGE RD APT 86
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City | CAMERON PARK
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State | CA
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Zip | 95682-9295
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Country | US
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Telephone | 916-416-4837
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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 | R1224420316
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License Number State | CA
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