Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003083742 |
---|---|
Provider Name | Tamara Ann Vukovich |
First Address | Auburn, CA 95602-9216 |
Second Address | Marysville, CA 95901-5834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 15/05/2008 |