Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003092099 |
---|---|
Provider Name | Oliver Maurice Henderson |
First Address | San Ramon, CA 94583-4187 |
Second Address | Richmond, CA 94804-1338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 05/02/2008 |