Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003138660 |
---|---|
Provider Name | Ms. Efstathia Perivoliotis |
First Address | San Jose, CA 95113-1112 |
Second Address | San Jose, CA 95113-1112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2010 |
Last Update Date | 25/08/2021 |