Individual
ALICE CENTENO TELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1204 W SHAW AVE # 102, FRESNO, CA 93711-3706
(559) 273-2942
Mailing address
178 W BARSTOW AVE APT B, FRESNO, CA 93704-2154
(559) 231-0949
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R8363
CA
Other
Enumeration date
05/16/2019
Last updated
05/16/2019
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