Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A022080216 | CA |
NPI | 1003363284 |
---|---|
Provider Name | Michael Koch |
First Address | Carlsbad, CA 92008-1657 |
Second Address | Carlsbad, CA 92008-1657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 06/09/2016 |