Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37CA00127800 | NJ |
NPI | 1003489832 |
---|---|
Provider Name | Christine Randina |
First Address | Lincoln Park, NJ 07035-1170 |
Second Address | Hackensack, NJ 07601-7143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2021 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0183385 | (05) | NJ |