Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1457874729 |
---|---|
Provider Name | Rena Raju |
First Address | Marysville, CA 95901-6205 |
Second Address | Marysville, CA 95901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 19/07/2017 |