Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1444470921 | CA |
NPI | 1003587403 |
---|---|
Provider Name | Latifa Aghattass |
First Address | Long Beach, CA 90806-4521 |
Second Address | Long Beach, CA 90806-4521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2021 |
Last Update Date | 24/09/2021 |