Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RIG0611061102 | CA |
NPI | 1003953910 |
---|---|
Provider Name | Keiko Grace |
First Address | San Francisco, CA 94117-2908 |
Second Address | San Francisco, CA 94103-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |