Individual
AUTUMN RAINBOW LINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 VIRGINIA AVE, MODESTO, CA 95354-0520
(209) 303-5501
Mailing address
108 VIRGINIA AVE, MODESTO, CA 95354-0520
(209) 303-5501
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
11425
CA
101YP2500X
Professional Counselor
Primary
20317
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/10/2019
Last updated
08/21/2025
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