Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003586215 |
---|---|
Provider Name | George Boyadjian |
First Address | Fresno, CA 93726-3102 |
Second Address | Fresno, CA 93711-1529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2021 |
Last Update Date | 18/09/2021 |