Individual
CARRIE PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3499 10TH ST, RIVERSIDE, CA 92501-3617
(951) 358-5859
Mailing address
3625 14TH ST, RIVERSIDE, CA 92501-3815
(951) 955-5631
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/10/2010
Last updated
08/14/2024
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