Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003088766 |
---|---|
Provider Name | Ms. Shelly Susan Flood |
First Address | Los Angeles, CA 90047-3327 |
Second Address | Los Angeles, CA 90047-3327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 01/04/2008 |