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NPI Code Detail

MEDICARE: ALISSA HADEN RADT, CHW

MEDICARE: ALISSA HADEN RADT, CHW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorR1587741124CA
2101YM0800XMental Health CounselorCA
3172V00000XCommunity Health Worker25-CCHW-00019CA

General Provider Information

NPI Number : 1548077639
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISSA HADEN RADT, CHW
Provider Business Mailing Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 888-638-8457
Fax Number :
Provider Business Practice Location Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 888-638-8457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2024
Last Update Date : 08/14/2025

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