Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053596684 |
---|---|
Provider Name | Mr. Marcus Knight |
First Address | Duarte, CA 91010-1919 |
Second Address | Pomona, CA 91767-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |