Provider Demographics
NPI:1215060009
Name:SHEDRICK, CHARLES NATHANIEL (CATS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:NATHANIEL
Last Name:SHEDRICK
Suffix:
Gender:M
Credentials:CATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2408
Mailing Address - Country:US
Mailing Address - Phone:818-207-5808
Mailing Address - Fax:
Practice Address - Street 1:3085 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4527
Practice Address - Country:US
Practice Address - Phone:626-791-0831
Practice Address - Fax:626-791-1592
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA030806OtherCATC CREDENTIAL