Provider Demographics
NPI:1053168963
Name:CELESTINE, CHERISH RENEE
Entity type:Individual
Prefix:
First Name:CHERISH
Middle Name:RENEE
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 ARDILLA AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3222
Mailing Address - Country:US
Mailing Address - Phone:058-464-4660
Mailing Address - Fax:
Practice Address - Street 1:5655 ARDILLA AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3222
Practice Address - Country:US
Practice Address - Phone:058-464-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1550630224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)