Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003080474 |
---|---|
Provider Name | Leilani Jane Carinio |
First Address | Garden Grove, CA 92840 |
Second Address | Newport Beach, CA 92660-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 17/03/2018 |