Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1290740218 | CA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RI-M1308062007 | CA |
NPI | 1003257841 |
---|---|
Provider Name | Mrs. Latoya Marie Mitchell |
First Address | Delano, CA 93215-2238 |
Second Address | Delano, CA 93215-2238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 13/11/2018 |