Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1288260118 | CA |
NPI | 1003999269 |
---|---|
Provider Name | Alycia L Cardona |
First Address | San Diego, CA 92108-4402 |
Second Address | San Diego, CA 92108-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 12/11/2019 |