Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MG60849490 | WA |
NPI | 1003278763 |
---|---|
Provider Name | Cassandra E Wilson |
First Address | Bellingham, WA 98225-5055 |
Second Address | Bellingham, WA 98225-5055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 01/12/2020 |