Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS19366 | CA |
N | 1041S0200X | School Social Worker | LCS19366 | CA |
NPI | 1003145814 |
---|---|
Provider Name | Jacqueline Kolchins |
First Address | Calabasas, CA 91302-1926 |
Second Address | Calabasas, CA 91302-1926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 08/12/2009 |