Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1013041839 |
---|---|
Provider Name | Mrs. Anicia R. Mclain |
First Address | San Bernardino, CA 92411-1652 |
Second Address | Fontana, CA 92336-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |