Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC 85 | CA |
NPI | 1003195066 |
---|---|
Provider Name | Diana To |
First Address | San Mateo, CA 94404-1596 |
Second Address | San Mateo, CA 94404-1596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 31/08/2014 |