Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CICA03470620 | CA |
NPI | 1003900515 |
---|---|
Provider Name | Mr. Joel Brandon Nelson |
First Address | Torrance, CA 90502 |
Second Address | Torrance, CA 90502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/03/2021 |