Provider Demographics
NPI:1437666898
Name:LARGE, ARLETTE ADELE (LCSW , CADC III,)
Entity type:Individual
Prefix:
First Name:ARLETTE
Middle Name:ADELE
Last Name:LARGE
Suffix:
Gender:F
Credentials:LCSW , CADC III,
Other - Prefix:
Other - First Name:ARLETTE
Other - Middle Name:ADELE
Other - Last Name:LARGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2400 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3502
Mailing Address - Country:US
Mailing Address - Phone:707-498-4325
Mailing Address - Fax:707-442-1191
Practice Address - Street 1:1026 N ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2047
Practice Address - Country:US
Practice Address - Phone:707-498-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABII00070619101YA0400X
OR153561041C0700X
CA1213671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA121367OtherBOARD OF BEHAVIORAL HEALTH ( LICENSED CLINICAL SOCIAL WORKER)
CABII00070619OtherCADCIII
CA015097OtherNCAC I
OR15356OtherBOARD OF LICENSED SOCIAL WORKERS LCSW