Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003332099 |
---|---|
Provider Name | Nicolette Nguyen |
First Address | Berkeley, CA 94702-0183 |
Second Address | Oakland, CA 94612-3811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 21/08/2017 |