Provider Demographics
NPI:1528425147
Name:CANTRELL, DONNA FREEMAN (CADC I CA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:FREEMAN
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:CADC I CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-4562
Mailing Address - Country:US
Mailing Address - Phone:209-525-7411
Mailing Address - Fax:209-541-2083
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-525-7493
Practice Address - Fax:209-541-2143
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI20031217101YA0400X
CA1442071374700000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374700000XNursing Service Related ProvidersTechnician