Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003264987 |
---|---|
Provider Name | Marissa Adams |
First Address | South Lake Tahoe, CA 96150-6305 |
Second Address | South Lake Tahoe, CA 96150-6305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 01/06/2016 |