Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003939513 |
---|---|
Provider Name | Ms. Jeani Callan |
First Address | Lompoc, CA 93436-6643 |
Second Address | Lompoc, CA 93436-6916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |