Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00002530 | WA |
Y | 101YM0800X | Mental Health Counselor | LH00004385 | WA |
NPI | 1003968330 |
---|---|
Provider Name | Gavin R Vilander |
First Address | Seattle, WA 98124-1584 |
Second Address | Spokane, WA 99201-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 17/07/2007 |