Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 207QA0401X | Family Doctor - Addiction Medicine | CDPT.CO.61129031 | WA |
NPI | 1285395103 |
---|---|
Provider Name | Marjorie Mae Suarez |
First Address | Pasco, WA 99301-3393 |
Second Address | Pasco, WA 99301-3393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 04/01/2022 |