Individual
BONNIE RENEE IRVING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-CAS
Contact information
Practice address
1733 EUCLID AVE, SAN DIEGO, CA 92105-5414
(619) 263-0433
Mailing address
1733 EUCLID AVE, SAN DIEGO, CA 92105-5414
(619) 263-0433
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37-20
—
CA
Enumeration date
09/13/2018
Last updated
09/13/2018
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