Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LISAC-10124 | AZ |
NPI | 1003156712 |
---|---|
Provider Name | Ms. Margaret Frances Bauman |
First Address | Avondale, AZ 85392-4863 |
Second Address | Avondale, AZ 85392-4863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2013 |
Last Update Date | 18/02/2013 |