Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 164498IV | CA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | AII051300218 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1265953939 |
---|---|
Provider Name | Garrett Lee |
First Address | Canoga Park, CA 91303-4255 |
Second Address | Canoga Park, CA 91303-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 06/05/2021 |