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General NPI Number Information
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NPI Number | 1831868595
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Entity Type | Individual
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Provider Name | CARISSA KIMBERLY PELLERIN SUBSTANCE ABUSE COUN
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 4544 SAN FERNANDO RD
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City | GLENDALE
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State | CA
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Zip | 91204-1987
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Country | US
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Telephone | 818-240-8843
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Fax | 818-240-8885
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Provider Business Mailing Address
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Address Line | 23520 STILLWATER PL
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City | SANTA CLARITA
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State | CA
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Zip | 91321-3555
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Country | US
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Telephone | 818-240-8843
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Fax | 818-240-8885
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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 | F7857329
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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 | CA
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