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Individual
OMAR MEDINA
Active
Individual
OMAR MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSW, QMHA
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
93-0841022
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679014
—
OR
Enumeration date
02/27/2017
Last updated
02/27/2017
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