Individual
SHANNON DENISE REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAS
Contact information
Practice address
5494 PONY EXPRESS TRAIL, POLLOCK PINES, CA 95726
(530) 644-3758
(530) 644-3782
Mailing address
PO BOX 586, CAMINO, CA 95709-0586
(530) 644-3758
(530) 644-3782
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
324500000X
CA
Other
Enumeration date
03/30/2009
Last updated
03/30/2009
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