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1902045354
EVAN DECKER
SOUTH LAKE TAHOE, CA
NPI
1902045354
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2009-02-09
Last Update Date
2009-02-09
Business Address
Mr. EVAN DECKER
1137 EMERALD BAY RD
SOUTH LAKE TAHOE, CA 96150-6207
Phone number: 530-541-5190
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Mailing Address
Mr. EVAN DECKER
1137 EMERALD BAY RD
SOUTH LAKE TAHOE, CA 96150-6207
Phone number: 530-541-5190
Copy
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