Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IMF 55900 | CA |
NPI | 1003066002 |
---|---|
Provider Name | Janice Graham |
First Address | Del Mar, CA 92014-3104 |
Second Address | Del Mar, CA 92014-3751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2008 |
Last Update Date | 13/12/2017 |