Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003115775 |
---|---|
Provider Name | Mr. Ante Baricevic |
First Address | Orangevale, CA 95662-5326 |
Second Address | Sacramento, CA 95826-3890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2011 |
Last Update Date | 30/08/2019 |