Andrea Clark Carmona, CADC I

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CI29070220 Issued in CA

Practice address

20331 Flanagan Road
Trabuco Canyon, CA 92679

Phone

(818) 582-8832

Fax

(818) 582-8836

NPI assigned

Oct 20, 2020

Last updated

Oct 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Teen Project, Inc.

  dba Vera's Sanctuary

  • Children's Substance Abuse Rehabilitation Facility
  • Trabuco Canyon, CA
  • NPI 1609345743
  NPD (past)

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1740889880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 WILD HORSE LOOP",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926881805",
            "telephone_number": "801-310-9227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20331 FLANAGAN ROAD",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "92679",
            "telephone_number": "818-582-8832",
            "fax_number": "818-582-8836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMONA",
        "first_name": "ANDREA",
        "middle_name": "CLARK",
        "credential": "CADC I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "CI29070220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bailey Lynn Caldwell, RADT
• Lora Ann Caldwell, MA, CATC IV
• Robert William Canova, D.C.
• Carlson Physical Therapy, Inc
• Timothy James Carlson, RPT
• Julio Cesar Carmona, LVN
• Sarah Diane Carmona
• Kamirah Carter
• Vanessa Rae Carter
• April Casillas, RADT

• Addiction (Substance Use Disorder) Counselor in Trabuco Canyon, CA
• Providers in Trabuco Canyon, 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 Oct 20, 2020; 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.