Individual
VINTRICA VICTORIA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 TULLY RD, SUITE F, MODESTO, CA 95350-2946
(209) 576-1750
Mailing address
2821 LOU ANN DR. #209, MODESTO, CA 95350
(209) 622-7915
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
36652
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/11/2012
Last updated
12/03/2013
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