Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RW5196 | CA |
NPI | 1003231051 |
---|---|
Provider Name | Richard Acaccia |
First Address | San Jose, CA 95128-2601 |
Second Address | San Jose, CA 95128-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 27/02/2014 |