Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAS-12041 | CA |
NPI | 1003160003 |
---|---|
Provider Name | Ms. Alicia Vera |
First Address | Los Angeles, CA 90061 |
Second Address | Los Angeles, CA 90061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 30/10/2012 |