Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0510111446 | CA |
NPI | 1003004979 |
---|---|
Provider Name | Justine Joyner |
First Address | Compton, CA 90222-1455 |
Second Address | Compton, CA 90222-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/10/2007 |