Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CI06960217 | CA |
NPI | 1003212697 |
---|---|
Provider Name | Duane Stigen |
First Address | Lotus, CA 95651 |
Second Address | Lotus, CA 95651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 05/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CI06960217 | CADC-I (01) | CA |