Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003281700 |
---|---|
Provider Name | Mr. Ron Mabry |
First Address | Fresno, CA 93702-2027 |
Second Address | Fresno, CA 93706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2015 |
Last Update Date | 07/12/2015 |