Individual
AMALIA MAYA LASTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 SCENIC DR, MODESTO, CA 95350-6131
(209) 605-5543
Mailing address
PO BOX 1859, MODESTO, CA 95353-1859
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
ASW76891
CA
104100000X
Social Worker
ASW76891
CA
1041C0700X
Clinical Social Worker
Primary
101067
CA
Other
Enumeration date
01/22/2018
Last updated
02/03/2022
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