Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1427700421 | CA |
NPI | 1003578477 |
---|---|
Provider Name | Piper Coleman |
First Address | Riverside, CA 92504-2037 |
Second Address | Riverside, CA 92504-2037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2021 |
Last Update Date | 12/10/2021 |