Individual
AMANDA DANIELLE MAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RADT
Contact information
Practice address
2220 GIRARD ST, SAN JACINTO, CA 92583-5301
(951) 925-8450
Mailing address
2220 GIRARD ST, SAN JACINTO, CA 92583-5301
(951) 925-8450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1425370421
CA
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/20/2021
Last updated
10/30/2023
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