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1174202386
JAZAIHA LANAE KELLEY
MODESTO, CA
NPI
1174202386
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2023-07-14
Last Update Date
2023-07-14
Business Address
JAZAIHA LANAE KELLEY
2700 BRENNER WAY
MODESTO, CA 95350-1704
Phone number: 559-241-3239
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Mailing Address
JAZAIHA LANAE KELLEY
2700 BRENNER WAY
MODESTO, CA 95350-1704
Phone number: 559-241-3239
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