Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RS4344 | CA |
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013188796 |
---|---|
Provider Name | Mrs. Linda M Miles |
First Address | Chino, CA 91710-1921 |
Second Address | Glendora, CA 91740-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 06/10/2008 |