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1174830699
WAIVERLY THOMAS
LONG BEACH, CA
NPI
1174830699
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2010-09-03
Last Update Date
2010-09-03
Business Address
-- WAIVERLY THOMAS
625 W 8TH ST
LONG BEACH, CA 90813-4003
Phone number: 323-667-5061
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Mailing Address
-- WAIVERLY THOMAS
625 W 8TH ST
LONG BEACH, CA 90813-4003
Phone number: 323-667-5061
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