Provider Demographics
NPI:1316237720
Name:CLINE, MICHAEL ANN (CADC LL -CA)
Entity type:Individual
Prefix:MISS
First Name:MICHAEL ANN
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:CADC LL -CA
Other - Prefix:
Other - First Name:MICHAEL ANN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18818 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2323
Mailing Address - Country:US
Mailing Address - Phone:760-995-8891
Mailing Address - Fax:
Practice Address - Street 1:1841 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3234
Practice Address - Country:US
Practice Address - Phone:760-909-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII10430815101YA0400X
CA360030AN251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316237720OtherDRUG MEDICAL