Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ASW34852 | CA |
NPI | 1003239641 |
---|---|
Provider Name | Miss Reneice Johntine Charles |
First Address | Los Angeles, CA 90026-4641 |
Second Address | Los Angeles, CA 90026-4641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2014 |
Last Update Date | 04/02/2014 |