Basic Information
| Provider Information | |||||||||
| NPI: | 1801098215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORRIS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | CAS II CERT, CADDAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 W CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953377300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092399600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 955 W CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953377300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092399600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 01/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 01-054876 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | HDC70114F | 05 | CA | MEDICAID |