NPI | 1619482155 |
---|---|
Former Name | LISA SANDOVAL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118274) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW79240) |
1041C0700X Social Worker, Clinical (Licence: CA ASW79240) | |
Enumeration Date | 2017-12-06 |
Last Update Date | 2023-10-05 |