Individual
NINA RAQUEL LYDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 W BRIGGSMORE AVE, MODESTO, CA 95350-3839
(209) 526-1476
Mailing address
2000 W BRIGGSMORE AVE, MODESTO, CA 95350-3839
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
22097
CA
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/19/2024
Last updated
03/03/2026
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