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Individual
NGOC LOI
Active
Individual
NGOC LOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
LCSW63571
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11262
SFGH INTERNAL USE ONLY
—
Enumeration date
03/26/2007
Last updated
09/30/2014
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