Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003053463 |
---|---|
Provider Name | Ms. Tiffany Lyn Sofie |
First Address | Covina, CA 91723-3186 |
Second Address | Covina, CA 91723-3186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 07/01/2009 |