Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60335346 | WA |
NPI | 1003247677 |
---|---|
Provider Name | Jennifer Roach |
First Address | Everett, WA 98201-2927 |
Second Address | Everett, WA 98201-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2013 |
Last Update Date | 09/12/2013 |