Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 5482 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013402734 |
---|---|
Provider Name | Adam Neal |
First Address | Panorama City, CA 91402-4827 |
Second Address | Panorama City, CA 91402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 05/09/2018 |