Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00003404 | WA |
NPI | 1003110800 |
---|---|
Provider Name | David Lewis Mcleod |
First Address | Tacoma, WA 98415-0305 |
Second Address | Tacoma, WA 98402-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 07/01/2011 |