Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | C030780215 | CA |
NPI | 1003357690 |
---|---|
Provider Name | Chase Parker |
First Address | Los Angeles, CA 90027 |
Second Address | Los Angeles, CA 90057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |