Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | B0509221152 | CA |
NPI | 1003243247 |
---|---|
Provider Name | Deborah Bolin |
First Address | San Carlos, CA 94070-8401 |
Second Address | Burlingame, CA 94010-1604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2013 |
Last Update Date | 02/10/2013 |