person
Gentry Boman, SUDRC
Addiction (Substance Use Disorder) Counselor in San Diego, California
NPI 1588330518

Gentry Boman is an Addiction (Substance Use Disorder) Counselor based in San Diego, CA and is specialized in Addiction (Substance Use Disorder). Gentry Boman practices in San Diego, CA and has the professional credentials of SUDRC. The NPI Number for Gentry Boman is 1588330518 and holds a License No. (California).

The current practice location address for Gentry Boman is 3340 Kemper St Ste 105, San Diego, CA and can be reached out via phone at 196-523-8121.

Location: 3340 Kemper St Ste 105, San Diego, CA, 92110-4907
person
Provider Profile Details
NPI Number
1588330518
Provider Name
Gentry Boman
Credential
SUDRC
Provider Entity Type
Individual
Gender
Female
Address
3340 Kemper St Ste 105, San Diego, CA, 92110-4907
Phone Number
196-523-8121
Fax Number
Provider Enumeration Date
08/19/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
373781 05 CA
institution
Provider Business Practice Location Address Details
Address
3340 Kemper St Ste 105
City
State
Zip
92110-4907
Phone Number
196-523-8121
Fax Number
person
Provider Business Mailing Address Details
Address
3340 Kemper St Ste 105
City
State
Zip
92110-4907
Phone Number
196-523-8121
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
(California)
Definition
Definition to come...
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