Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12649 | CA |
NPI | 1003575424 |
---|---|
Provider Name | Anthwan Jovan Bell |
First Address | Anaheim, CA 92805-2651 |
Second Address | Anaheim, CA 92805-2651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |