Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003170796 |
---|---|
Provider Name | Heather M Mann |
First Address | Alameda, CA 94501-7061 |
Second Address | Alameda, CA 94501-7061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8121 | (05) | CA |