Provider Demographics
NPI:1962160465
Name:COTTON, FREDERICK THOMAS (RADT 1)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:THOMAS
Last Name:COTTON
Suffix:
Gender:M
Credentials:RADT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 LIGHTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-5910
Mailing Address - Country:US
Mailing Address - Phone:510-472-1817
Mailing Address - Fax:
Practice Address - Street 1:3707 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6101
Practice Address - Country:US
Practice Address - Phone:925-522-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1317520818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor