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1013368083
STANLEY BRAGG
SANTA ROSA, CA
NPI
1013368083
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 7744-r)
Enumeration Date
2016-06-30
Last Update Date
2016-06-30
Business Address
-- STANLEY BRAGG
6119 MONTECITO BLVD APT 12
SANTA ROSA, CA 95409-2969
Phone number: 707-888-2592
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Mailing Address
-- STANLEY BRAGG
6119 MONTECITO BLVD APT 12
SANTA ROSA, CA 95409-2969
Phone number: 707-888-2592
Copy
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