Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | CG60914217 | WA |
NPI | 1003326190 |
---|---|
Provider Name | Kayla-Ann Pembleton |
First Address | Vancouver, WA 98668-1845 |
Second Address | Vancouver, WA 98661-7254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2017 |
Last Update Date | 05/02/2021 |