Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | P-1811 | NE |
NPI | 1003429028 |
---|---|
Provider Name | Diana Aracely Camacho |
First Address | Norfolk, NE 68702-2315 |
Second Address | Norfolk, NE 68701-3197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |