Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1306325998 |
---|---|
Provider Name | Vallerie Chacon |
First Address | San Bernardino, CA 92401-1217 |
Second Address | San Bernardino, CA 92401-1217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 16/04/2021 |