Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1033468905 |
---|---|
Provider Name | Frank Edwin Weaver |
First Address | Santa Maria, CA 93455-1337 |
Second Address | Santa Maria, CA 93455-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 21/12/2012 |