Provider Demographics
NPI:1285400556
Name:MCMILLEN, CHERYL ANNE (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1562
Mailing Address - Country:US
Mailing Address - Phone:916-532-9771
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1562
Practice Address - Country:US
Practice Address - Phone:916-532-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1552270324101YA0400X
CAMPSS-ERJOAP175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)