Provider Demographics
NPI:1619495371
Name:PALMER, SHELIA ANN (SUD COUNSELOR II)
Entity type:Individual
Prefix:
First Name:SHELIA
Middle Name:ANN
Last Name:PALMER
Suffix:
Gender:F
Credentials:SUD COUNSELOR II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20228 DALFSEN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2934
Mailing Address - Country:US
Mailing Address - Phone:310-384-4907
Mailing Address - Fax:
Practice Address - Street 1:117 E HARRY BRIDGES BLVD # A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5825
Practice Address - Country:US
Practice Address - Phone:310-384-4907
Practice Address - Fax:310-835-1202
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI31750121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid