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1487438594
RAEVIN NICKERSON
FAIRFIELD, CA
NPI
1487438594
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1521270823)
Enumeration Date
2023-08-21
Last Update Date
2023-08-21
Business Address
RAEVIN NICKERSON RAD-T
1225 TRAVIS BLVD
FAIRFIELD, CA 94533-4892
Phone number: 707-399-9105
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Mailing Address
RAEVIN NICKERSON RAD-T
609 JEFFERSON ST
FAIRFIELD, CA 94533-6293
Phone number: 073-999-1907
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