Individual provider · Type 1 NPI

Clyde Ellis Virges, CADC II1953

Addiction (Substance Use Disorder) Counselor · San Jose, CA

NPI number 1134428162 Active

Practice location

614 Tully Rd
San Jose, CA 95111-1048

Call (408) 977-1591 Map

Fax (408) 977-1136

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XE0312796 (CA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1134428162

Clyde Ellis Virges, CADC II1953's National Provider Identifier is 1134428162, issued on Mar 16, 2011. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in San Jose, CA. The record was last updated on Sep 29, 2026.