CLYDE ELLIS VIRGES

SAN JOSE, CA
NPI1134428162
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  E0312796)
Enumeration Date2011-03-16
Last Update Date2011-03-16
Business Address
-- CLYDE ELLIS VIRGES CADC II09181953
614 TULLY RD
SAN JOSE, CA 95111-1048
Phone number: 408-977-1591
Mailing Address
-- CLYDE ELLIS VIRGES CADC II09181953
614 TULLY RD
SAN JOSE, CA 95111-1048
Phone number: 408-977-1591
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