Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ASW79885 | CA |
NPI | 1003207291 |
---|---|
Provider Name | Mr. Charles David Carr |
First Address | Los Angeles, CA 90012-4112 |
Second Address | Los Angeles, CA 90038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2015 |
Last Update Date | 17/08/2018 |