Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1255936233 |
---|---|
Provider Name | Mrs. Anna Jung |
First Address | Daly City, CA 94015-2801 |
Second Address | San Carlos, CA 94070-2317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2020 |
Last Update Date | 30/11/2020 |