Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CA |
NPI | 1003463076 |
---|---|
Provider Name | Ms. Laronette Perry |
First Address | Suisun City, CA 94585-2308 |
Second Address | Oakland, CA 94609-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |