Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS 22608 | CA |
NPI | 1003144940 |
---|---|
Provider Name | Terri Hiroshima-Chan |
First Address | Davis, CA 95616-4608 |
Second Address | Davis, CA 95616-4608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2009 |
Last Update Date | 04/12/2009 |