Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | IMF70104 | CA |
NPI | 1003288655 |
---|---|
Provider Name | Ms. Sacheen Thompson |
First Address | Antioch, CA 94509-6134 |
Second Address | Antioch, CA 94509-6134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 21/07/2020 |