Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003292749 |
---|---|
Provider Name | Andrea Martin |
First Address | Sacramento, CA 95841-4139 |
Second Address | Sacramento, CA 95841-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 05/08/2015 |