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Individual

ALISA VICTORIA ADAME

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
820 E GILBERT ST, SAN BERNARDINO, CA 92415-2847
(909) 387-7200
Mailing address
820 E GILBERT ST, SAN BERNARDINO, CA 92415-3405
(909) 387-7200

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
106H00000X
Marriage & Family Therapist
Primary
136152
CA
106H00000X
Marriage & Family Therapist
CA
390200000X
Student in an Organized Health Care Education/Training Program
CA

Other

Enumeration date
06/13/2019
Last updated
03/22/2024
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