Provider Demographics
NPI:1205318581
Name:SALMON, FELICIA (MA, SUDRC #8591)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:SALMON
Suffix:
Gender:F
Credentials:MA, SUDRC #8591
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7281 GARDEN GROVE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4212
Mailing Address - Country:US
Mailing Address - Phone:714-539-4544
Mailing Address - Fax:
Practice Address - Street 1:7281 GARDEN GROVE BLVD STE H
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4212
Practice Address - Country:US
Practice Address - Phone:909-623-6391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8591101YA0400X, 101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)