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Individual
COLE STOCKTON
Active
Individual
COLE STOCKTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NA
CA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
05/09/2013
Last updated
11/20/2018
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