Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CA |
NPI | 1003244302 |
---|---|
Provider Name | Mrs. Dene Logan Selkin |
First Address | Marina Del Rey, CA 90292-5872 |
Second Address | Marina Del Rey, CA 90292-5872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |