Provider Demographics
NPI:1962181156
Name:STAVRIDES, NICHOLAS (CADC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:STAVRIDES
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 CAMPISI WAY
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2340
Mailing Address - Country:US
Mailing Address - Phone:917-325-4913
Mailing Address - Fax:
Practice Address - Street 1:910 CAMPISI WAY
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2340
Practice Address - Country:US
Practice Address - Phone:408-462-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI37041222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)