Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 74159 | CA |
NPI | 1003256355 |
---|---|
Provider Name | Mrs. Kathleen Patrice James |
First Address | Apple Valley, CA 92307-1221 |
Second Address | Apple Valley, CA 92307-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 25/10/2016 |