Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6230 | CA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CACS5241018 | CA |
NPI | 1003160912 |
---|---|
Provider Name | Gilbert Diallo Madison |
First Address | Anaheim, CA 92804-4525 |
Second Address | Anaheim, CA 92804-4525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 15/10/2020 |