Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 708 INTERN NUMBER | CA |
NPI | 1003233412 |
---|---|
Provider Name | Leticia Ross |
First Address | Hawthorne, CA 90250-2366 |
Second Address | Hawthorne, CA 90250-2366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 24/03/2014 |