| NPI | 1699543736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATESHA KING Officer 951-992-2665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 251S00000X | |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |