Provider Demographics
NPI:1073061347
Name:GIDDENS, KERI (CADC-CAS,)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:CADC-CAS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6232
Mailing Address - Country:US
Mailing Address - Phone:559-732-4885
Mailing Address - Fax:559-732-8289
Practice Address - Street 1:1646 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4962
Practice Address - Country:US
Practice Address - Phone:559-625-8890
Practice Address - Fax:559-733-5053
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-2706719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)