Provider Demographics
NPI:1174812549
Name:MONTECINO, DAVID JOSEPH (LADC, ADCR-MN, NCPT3)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:MONTECINO
Suffix:
Gender:M
Credentials:LADC, ADCR-MN, NCPT3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-763-0063
Mailing Address - Fax:
Practice Address - Street 1:15 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3351
Practice Address - Country:US
Practice Address - Phone:612-454-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MN302378101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)