Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CATC# 071372 | CA |
NPI | 1003022526 |
---|---|
Provider Name | Robert Thayne Hake |
First Address | Ukiah, CA 95482-6340 |
Second Address | Ukiah, CA 95482-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |