Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1144700832 |
---|---|
Provider Name | Nicole Samuels |
First Address | Irvine, CA 92604-3607 |
Second Address | Long Beach, CA 90813-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 23/08/2021 |