Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003240698 |
---|---|
Provider Name | Sara Chambers |
First Address | San Rafael, CA 94903-3696 |
Second Address | San Rafael, CA 94903-3696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 30/08/2013 |