Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 680184117 | CA |
NPI | 1003413691 |
---|---|
Provider Name | Ascari Walker |
First Address | Rancho Cordova, CA 95670-4147 |
Second Address | Sacramento, CA 95823-1884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2020 |
Last Update Date | 06/10/2020 |