Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003220997 |
---|---|
Provider Name | Ms. Indira Lopez |
First Address | Santa Barbara, CA 93110-1848 |
Second Address | Santa Barbara, CA 93110-1848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 18/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B9551486 | CA DL (01) | CA |