Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6973-R | CA |
NPI | 1003577677 |
---|---|
Provider Name | Teri Musser |
First Address | Santa Rosa, CA 95403-3127 |
Second Address | Santa Rosa, CA 95403-3127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2022 |
Last Update Date | 06/01/2022 |