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General NPI Number Information
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NPI Number | 1134718919
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Entity Type | Individual
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Provider Name | KIRSTEN NICOLE CARRILLO SUD
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 215 W BEAMER ST
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City | WOODLAND
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State | CA
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Zip | 95695-2510
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Country | US
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Telephone | 530-405-2815
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Fax |
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Provider Business Mailing Address
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Address Line | 215 W BEAMER ST
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City | WOODLAND
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State | CA
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Zip | 95695-2510
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Country | US
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Telephone | 530-405-2815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12064
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AII050060623
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License Number State | CA
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