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1194260877
JESSICA KOSTELIC
SAN RAFAEL, CA
NPI
1194260877
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 9826-R)
Enumeration Date
2017-01-04
Last Update Date
2017-01-04
Business Address
-- JESSICA KOSTELIC
1466 LINCOLN AVE
SAN RAFAEL, CA 94901-2021
Phone number: 415-457-3755
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Mailing Address
-- JESSICA KOSTELIC
1466 LINCOLN AVE
SAN RAFAEL, CA 94901-2021
Phone number: 415-457-3755
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