Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10019 | TX |
NPI | 1003181280 |
---|---|
Provider Name | Jennifer Marie Marroquin |
First Address | Corpus Christi, TX 78411-2801 |
Second Address | Houston, TX 77017-6544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 20/03/2012 |