Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | L20000395239 | FL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1437746062 |
---|---|
Provider Name | O'hara Tommie |
First Address | Hollywood, FL 33021-3241 |
Second Address | Hollywood, FL 33021-3241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2020 |
Last Update Date | 29/12/2020 |