Cedric Antron Staton, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11040 Issued in CA

Practice address

2525 Camino del Rio S Ste 313
San Diego, CA 92108-3784

Phone

(442) 322-8143

Fax

(619) 598-0594

NPI assigned

Dec 8, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648339200000",
    "number": "1417616236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2772 PIANTINO CIR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084736",
            "telephone_number": "704-492-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CAMINO DEL RIO S STE 313",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083784",
            "telephone_number": "442-322-8143",
            "fax_number": "619-598-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATON",
        "first_name": "CEDRIC",
        "middle_name": "ANTRON",
        "name_prefix": "Mr.",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-08",
        "last_updated": "2022-03-27",
        "certification_date": "2022-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "11040",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF BEHAVIORAL SCIENCES",
            "identifier": "LPCC11040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodi Staszak
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• State of California Prison Industry Authority
• Bailee State
• Emily Vu States
• Cierah Jahnelle Staton
• Robert Staton, IDC
• Michael F Statzula
• Kara Stauder
• Alyssa Maria Staudinger

• Mental Health Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; 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.