Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1351610619 | CA |
NPI | 1003573205 |
---|---|
Provider Name | Annette Elizabeth Imperatrice Farmer |
First Address | Visalia, CA 93277-4962 |
Second Address | Visalia, CA 93277-4962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2021 |
Last Update Date | 22/11/2021 |