Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CA |
NPI | 1003036682 |
---|---|
Provider Name | Lionela Evers |
First Address | Gardena, CA 90247-6000 |
Second Address | Los Angeles, CA 90062-2333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6926 | PROVIDER NUMBER (01) | CA |