Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A0412300925 | CA |
NPI | 1003940065 |
---|---|
Provider Name | Rachel J Avila |
First Address | Santa Rosa, CA 95407-5441 |
Second Address | Santa Rosa, CA 95407-5441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |