Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 60154890 | WA |
NPI | 1003236530 |
---|---|
Provider Name | Deborah Fredson |
First Address | Port Angeles, WA 98362-6129 |
Second Address | Port Angeles, WA 98362-6129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 23/04/2014 |