Individual
DEITRA DEAN MCMAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 FREDERICK ST STE C, SANTA CRUZ, CA 95062-2239
(831) 996-1222
Mailing address
PO BOX 7691, SANTA CRUZ, CA 95061-7691
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ASW85759
CA
Other
Enumeration date
04/19/2020
Last updated
04/19/2020
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