Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 60979141 | WA |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60979141 | WA |
NPI | 1003464355 |
---|---|
Provider Name | Ariel Jones |
First Address | Longview, WA 98632-8140 |
Second Address | Kelso, WA 98626-1638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2019 |
Last Update Date | 21/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2140687 | (05) | WA |