Provider Demographics
NPI:1134254592
Name:RALSTON, CHERYL LYNN (CADC II-A4350109)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:RALSTON
Suffix:
Gender:F
Credentials:CADC II-A4350109
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:RALSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:A4350109
Mailing Address - Street 1:PO BOX 3218
Mailing Address - Street 2:504 BERNARD STREET
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-3218
Mailing Address - Country:US
Mailing Address - Phone:661-637-2187
Mailing Address - Fax:661-326-1342
Practice Address - Street 1:504 BERNARD ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3018
Practice Address - Country:US
Practice Address - Phone:661-637-2187
Practice Address - Fax:661-326-1342
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4350109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4350109OtherCCAPP