Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RADT-I R76151214 | CA |
NPI | 1003358540 |
---|---|
Provider Name | Alfred Freeman |
First Address | Los Angeles, CA 90021-1009 |
Second Address | Los Angeles, CA 90021-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2016 |
Last Update Date | 15/11/2016 |