Individual
KHADEEJAH MAARIYAH BAAREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3125 MYERS ST # 3, RIVERSIDE, CA 92503-5527
(909) 223-7717
Mailing address
3525 PRESLEY AVE, RIVERSIDE, CA 92507-4453
(951) 955-0971
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CI3864052
CA
171M00000X
Case Manager/Care Coordinator
CI3864052
CA
175T00000X
Peer Specialist
Primary
MPSS-AUQCTE
CA
Other
Enumeration date
06/06/2022
Last updated
04/29/2024
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