Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4212 | LA |
NPI | 1003440090 |
---|---|
Provider Name | Calvin Pep |
First Address | New Orleans, LA 70119-7499 |
Second Address | New Orleans, LA 70119-7499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
455588957 | (05) | LA |