Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225C00000X | Rehabilitation Counselor | CRC 00108799 | CA |
NPI | 1265685804 |
---|---|
Provider Name | Ms. Dena Linn Sidmore |
First Address | San Pedro, CA 90731-3740 |
Second Address | San Pedro, CA 90731-3740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 30/10/2008 |