Individual
ASHLEE GABRIAL DEHERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCAPP REG. INTERN
Contact information
Practice address
335 6TH ST, HOLLISTER, CA 95023-3834
(831) 265-7317
Mailing address
335 6TH ST, HOLLISTER, CA 95023-3834
(831) 265-7317
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
TBA-0000
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TBA-0000
CCAPP REG INTERN
CA
Enumeration date
05/22/2018
Last updated
05/22/2018
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