Provider Demographics
NPI:1447085121
Name:GIFT, BENJAMIN (CADC-I)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:GIFT
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15631 WILLIAMS ST APT 70
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4832
Mailing Address - Country:US
Mailing Address - Phone:815-616-0884
Mailing Address - Fax:
Practice Address - Street 1:15631 WILLIAMS ST APT 70
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4832
Practice Address - Country:US
Practice Address - Phone:815-616-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI43040624101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)