Provider Demographics
NPI:1245444934
Name:RILEY, MICHELLE (CADC - II)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:CADC - II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 SAN FERNANDO RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-5015
Mailing Address - Country:US
Mailing Address - Phone:818-744-7189
Mailing Address - Fax:
Practice Address - Street 1:11321 CAMARILLO ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1216
Practice Address - Country:US
Practice Address - Phone:818-506-4455
Practice Address - Fax:818-506-5185
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)