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MS. ILSE AHUMADA AA
Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1871156364
Individual Registrant:MS. ILSE AHUMADA AA
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
1628 BROADWAY ST STE B VALLEJO, CA 94590-2405 US
Tel: 707-649-8300 Fax: --
Tel: 707-649-8300 Fax: --
Contact information for business:
425 ARKANSAS ST VALLEJO, CA 94590-3872 US
Tel: 707-805-6374 Fax: --
Tel: 707-805-6374 Fax: --
Registration Information:
NPI: 1871156364
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | CA | R1285781217 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
