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Individual provider · Addiction (Substance Use Disorder) Counselor · Azusa, CA

NPI
1336094572
Type
Individual (Type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor (Counselor)
Specialty group
Behavioral Health & Social Service Providers
Taxonomy code
101YA0400X
License number
24625 (CA)
Sex
Male
Sole proprietor
Yes
Enumerated
2026-03-03
Last updated
2026-03-03
Practice location
23701 E East Fork Rd
Azusa, CA 91702-1477
(877) 507-6242

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