Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 8233 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1104101310 |
---|---|
Provider Name | Sara R Vankoningsveld |
First Address | Los Angeles, CA 90064-8314 |
Second Address | Venice, CA 90291-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2011 |
Last Update Date | 29/10/2020 |