Clinton W. Aldrich, CADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · St Maries, ID
NPI 1124305347 · NPPES record last updated Nov 16, 2011
Key facts
- NPI
- 1124305347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 10045 (ID)
- Practice address
- 89 Homer Dr
St Maries, ID 83861-5078 - Phone
- (208) 245-5427
- Fax
- (209) 245-5425
- NPI assigned
- Nov 16, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10045 | ID | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 10045 | ID | Yes |
Addresses
Primary practice location
89 Homer Dr
St Maries, ID 83861-5078
Mailing address
89 Homer Dr
St Maries, ID 83861-5078
Phone (208) 245-5427
Other providers in St Maries, ID
- Michael David Abrahams
- Shayne M. Aguirre
- Alliance Family Services
- Alliance Family Services North, Inc.
- Shannon Allman
- Alternative Community Enrichment Services, Inc
- Alternative Community Enrichment Services, Inc
All providers in St Maries, ID · Addiction (Substance Use Disorder) Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.