Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1251310517 | CA |
NPI | 1003331448 |
---|---|
Provider Name | Rebecca Manzo |
First Address | Sacramento, CA 95838-3512 |
Second Address | Sacramento, CA 95838-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R1251310517 | CCAPP (01) | CA |