Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003090903 |
---|---|
Provider Name | James C Washington |
First Address | Tahlequah, OK 74465-0558 |
Second Address | Wagoner, OK 74467-7513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 27/12/2007 |