Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 30175 | NY |
NPI | 1003291675 |
---|---|
Provider Name | Dana Burton |
First Address | Huntington, NY 11743-4436 |
Second Address | Huntington, NY 11743-4436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 25/07/2015 |