Individual
STAR CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II, ICADC, MATS
Contact information
Practice address
3637 MISSION AVE BLDG B, CARMICHAEL, CA 95608-2946
(916) 485-4175
Mailing address
1329 HOWE AVE STE 201, SACRAMENTO, CA 95825-3363
(916) 333-3800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/28/2006
Last updated
05/23/2025
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