Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY13350 | CA |
NPI | 1528450384 |
---|---|
Provider Name | Nancy Waite-O'brien |
First Address | Mountain Center, CA 92561-4023 |
Second Address | Mountain Center, CA 92561-4023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 03/03/2015 |