Individual
ADAM SHAWN VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
545 N MAGNOLIA AVE, EL CAJON, CA 92020-3608
(619) 579-0947
Mailing address
545 N MAGNOLIA AVE, EL CAJON, CA 92020-3608
(619) 579-0947
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RW6051
CA
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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