Doctor Name: | MS. DANA MONIQUE OTIS |
NPI Number: | 1053451740 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CAARR |
License Number: | 03-037293 |
Business Practice Address: | 3707 Sunset Ln Antioch, CA - 945096101 |
Business Phone Number: | 9255220124 |
Business Fax Number: | 9255220133 |
Mailing Address: | 3707 Sunset Ln, ANTIOCH |
State: | CA |
Postal Code: | 945096101 |
Phone Number: | 9255220124 |
Fax Number: | 9255220133 |
NPI Enumeration Date: | 02/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 03-037293 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |