Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003127523 |
---|---|
Provider Name | Jerome Love |
First Address | Sacramento, CA 95816-4364 |
Second Address | Sacramento, CA 95818-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 30/06/2010 |