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1033530274
DIANE VICKERMAN
SAN ANDREAS, CA
NPI
1033530274
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2013-12-13
Last Update Date
2013-12-13
Business Address
-- DIANE VICKERMAN
891 MOUNTAIN RANCH RD
SAN ANDREAS, CA 95249-9713
Phone number: 209-890-7717
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Mailing Address
-- DIANE VICKERMAN
PO BOX 5222
BEAR VALLEY, CA 95223-5222
Phone number: 209-890-7717
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