Provider Demographics
NPI:1194135715
Name:FISHELL, JAMES VICTOR III (CADC-1)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:VICTOR
Last Name:FISHELL
Suffix:III
Gender:M
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 COBBLESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4604
Mailing Address - Country:US
Mailing Address - Phone:951-254-6998
Mailing Address - Fax:
Practice Address - Street 1:12770 COBBLESTONE CIR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4604
Practice Address - Country:US
Practice Address - Phone:951-254-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI3240608101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI3240608OtherCAADAC