Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003272931 |
---|---|
Provider Name | Charrae Rose Allen |
First Address | Tacoma, WA 98465-2117 |
Second Address | Tacoma, WA 98465-2117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 07/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CG60561697 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |