Provider Demographics
NPI:1235504762
Name:CASSELMAN, NIA (A049120218 CCAPP)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:CASSELMAN
Suffix:
Gender:F
Credentials:A049120218 CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 PALMDALE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9364
Mailing Address - Country:US
Mailing Address - Phone:626-975-9226
Mailing Address - Fax:
Practice Address - Street 1:13333 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9364
Practice Address - Country:US
Practice Address - Phone:626-975-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAA049120218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)