Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP 6009335 | WA |
Y | 101YM0800X | Mental Health Counselor | LH 60063024 | WA |
NPI | 1013034073 |
---|---|
Provider Name | Denise Dishongh |
First Address | Vancouver, WA 98661-6812 |
Second Address | Vancouver, WA 98661-6812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 16/11/2020 |