Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 60881285 | WA |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003376195 |
---|---|
Provider Name | Kelli Alexander |
First Address | Longview, WA 98632-8140 |
Second Address | Aberdeen, WA 98520-4333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2019 |
Last Update Date | 21/11/2019 |