Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1352340619 | CA |
NPI | 1003475062 |
---|---|
Provider Name | Mrs. Yvonne Martinez Thomas |
First Address | Placerville, CA 95667-4406 |
Second Address | Placerville, CA 95667-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 29/07/2020 |