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Individual
LISA M MEDINA
Active
Individual
LISA M MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RH0010460323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A063381123
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
R1298150318
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2018
Last updated
11/03/2023
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