Timothy William Pettett, SUDRC16547
Timothy William Pettett, SUDRC16547 is a Counselor in San Jose, California. Licensed in California. Registered with an NPI since 2022.
- Licensed in
- CA
- In the registry since
- 2022
Practice location Address checks out
298 Bernal RdSan Jose, CA 95119-1809
Phone: (510) 337-7950
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Specialties & licences
| Counselor (primary) | Taxonomy 101Y00000X (CA) |
|---|
Record details
| NPI number | 1104545490 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | SUDRC16547 |
| Sole proprietor | No |
| NPI enumerated | August 22, 2022 |
| Last updated in NPPES | October 20, 2024 |
| Certification date | October 20, 2024 |
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