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General NPI Number Information
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NPI Number | 1750929006
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Entity Type | Individual
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Provider Name | SHANI MARIE LYONS
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 103 SHORELINE PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94901-5581
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Country | US
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Telephone | 415-713-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 7231 PLANK AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-2039
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Country | US
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Telephone | 415-794-2315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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