Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | LPCC5006 | CA |
NPI | 1003125451 |
---|---|
Provider Name | Amanda Garrison |
First Address | San Diego, CA 92123-1308 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2010 |
Last Update Date | 11/06/2018 |