Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1437580594 |
---|---|
Provider Name | Kasey Elaine Amick I |
First Address | Lompoc, CA 93436-6033 |
Second Address | Lompoc, CA 93436-6033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 27/11/2013 |