RAEVIN NICKERSON

FAIRFIELD, CA
NPI1487438594
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: CA  R1521270823)
Enumeration Date2023-08-21
Last Update Date2023-08-21
Business Address
RAEVIN NICKERSON RAD-T
1225 TRAVIS BLVD
FAIRFIELD, CA 94533-4892
Phone number: 707-399-9105
Mailing Address
RAEVIN NICKERSON RAD-T
609 JEFFERSON ST
FAIRFIELD, CA 94533-6293
Phone number: 073-999-1907
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