Individual
CHARLISHA SUMLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT R1329651118
Contact information
Practice address
1760 FREMONT BLVD STE E1, SEASIDE, CA 93955-3615
(831) 393-9316
(831) 899-6565
Mailing address
224 CYPRESS AVE APT 6, MARINA, CA 93933-3834
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RADTR1329651118
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R1329651118
CCAPP
CA
Enumeration date
12/06/2018
Last updated
12/06/2018
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