Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1255888384 |
---|---|
Provider Name | Cierra Gromoff |
First Address | Fairfield, CA 94533-5702 |
Second Address | Fairfield, CA 94533-5702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 10/09/2019 |