Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00002245 | WA |
Y | 101YM0800X | Mental Health Counselor | LH00005465 | WA |
NPI | 1003979956 |
---|---|
Provider Name | Joann Shepherd |
First Address | Seattle, WA 98122-2735 |
Second Address | Seattle, WA 98115-2157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 15/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP00002245 | CHEMICAL DEPENDANCY PROF (01) | WA |