Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60372883 | WA |
NPI | 1003207788 |
---|---|
Provider Name | Jessica Hinckley |
First Address | Shoreline, WA 98155 |
Second Address | Shoreline, WA 98155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 17/02/2015 |