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1821782012
TARA ANN KHAWAJA
SAN RAFAEL, CA
NPI
1821782012
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 15165)
Enumeration Date
2023-06-08
Last Update Date
2023-06-08
Business Address
TARA ANN KHAWAJA SUDRC
1477 LINCOLN AVE
SAN RAFAEL, CA 94901-2028
Phone number: 415-459-2395
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Mailing Address
TARA ANN KHAWAJA SUDRC
1601 2ND ST STE 104
SAN RAFAEL, CA 94901-2701
Phone number: 415-459-2395
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