Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003227307 |
---|---|
Provider Name | Delane Yvonne Beaner |
First Address | El Cajon, CA 92020-1650 |
Second Address | El Cajon, CA 92020-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 08/05/2014 |