Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003448754 |
---|---|
Provider Name | Jene Nicole Hinton-Railsback |
First Address | San Luis Obispo, CA 93401-4558 |
Second Address | San Luis Obispo, CA 93401-4558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 06/11/2020 |