Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | S0504101451 | CA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | CA |
NPI | 1083824254 |
---|---|
Provider Name | Janice Stimson |
First Address | West Los Angeles, CA 90025-2587 |
Second Address | West Los Angeles, CA 90025-2551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 27/03/2020 |