Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CG 60274961 | WA |
NPI | 1003231259 |
---|---|
Provider Name | Marcus Slater |
First Address | Tacoma, WA 98407-3715 |
Second Address | Tacoma, WA 98407-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 25/02/2014 |