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1548008162
SAMUEL ELIJAH THIBODEAUX
ANAHEIM, CA
NPI
1548008162
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA 008210973)
Enumeration Date
2024-07-17
Last Update Date
2024-07-24
Business Address
SAMUEL ELIJAH THIBODEAUX
601 S HARBOR BLVD
ANAHEIM, CA 92805-4521
Phone number: 714-908-0028
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Mailing Address
SAMUEL ELIJAH THIBODEAUX
16662 IRBY LN
HUNTINGTON BEACH, CA 92647-4919
Phone number: 737-318-5140
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