Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003939281 |
---|---|
Provider Name | Mr. Tomas Lajias Morales |
First Address | Stockton, CA 95203-3219 |
Second Address | Frenchcamp, CA 95231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |