Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 7738 | CA |
Y | 101YP2500X | Professional Counselor | 4828 | CA |
NPI | 1003247131 |
---|---|
Provider Name | Aaron James White |
First Address | Covina, CA 91723-2024 |
Second Address | Covina, CA 91723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003247131 | (05) | CA |
1003247131 | OUTPATIENT/CLINIC (01) | CA |