Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | LCS23286 | CA |
N | 225400000X | Rehabilitation Practitioner | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1093767204 |
---|---|
Provider Name | Theresia Choi Bae |
First Address | Van Nuys, CA 91406-4458 |
Second Address | Van Nuys, CA 91406-4458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 11/09/2019 |