Provider Demographics
NPI:1184877979
Name:RILEY, NICOLE (CADC II, BSW, MSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:CADC II, BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6765 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8984
Mailing Address - Country:US
Mailing Address - Phone:530-622-5551
Mailing Address - Fax:530-622-5800
Practice Address - Street 1:211 NEW MORNING CT
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5446
Practice Address - Country:US
Practice Address - Phone:530-626-4190
Practice Address - Fax:530-622-2589
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-089877174400000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA013530315OtherCALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS
CA03-089877OtherCAARR