Provider Demographics
NPI:1144980269
Name:DEDMON, DANIEL WILLIAM (RAS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM
Last Name:DEDMON
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3714
Mailing Address - Country:US
Mailing Address - Phone:831-262-0024
Mailing Address - Fax:
Practice Address - Street 1:8 SUN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3714
Practice Address - Country:US
Practice Address - Phone:831-262-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10337101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10337OtherRAS