Individual
AJIA MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11776 MARIPOSA RD # 103, HESPERIA, CA 92345-1622
(760) 956-2462
Mailing address
11776 MARIPOSA RD # 103, HESPERIA, CA 92345-1622
(760) 956-2462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
MEDI-CAL
CA
Enumeration date
10/07/2014
Last updated
10/07/2014
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