Individual
ANNIE A LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT INTERN
Contact information
Practice address
769 W BLAINE ST, SUITE 241, RIVERSIDE, CA 92507-3970
(951) 358-5196
Mailing address
769 W BLAINE ST, RIVERSIDE, CA 92507-3970
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/20/2008
Last updated
02/13/2014
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