Donovan Waller Ackley III, PH.D. RADT-1

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1400 N Johnson Ave
101
El Cajon, CA 92020-1650

Phone

(619) 442-0277

Fax

(619) 442-1101

NPI assigned

Sep 27, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Heath Adam Ackley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1154870442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N JOHNSON AVE",
            "address_2": "101",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920201650",
            "telephone_number": "619-442-0277",
            "fax_number": "619-442-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N JOHNSON AVE",
            "address_2": "101",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920201650",
            "telephone_number": "619-442-0277",
            "fax_number": "619-442-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKLEY",
        "first_name": "DONOVAN",
        "middle_name": "WALLER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D. RADT-1",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-27",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATH",
            "last_name": "ACKLEY",
            "middle_name": "ADAM",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in El Cajon, CA
• Providers in El Cajon, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.