Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | WA |
NPI | 1003485475 |
---|---|
Provider Name | Merissa Donta Mechela Tryven Hull |
First Address | Seattle, WA 98108-4141 |
Second Address | Sedro Woolley, WA 98284-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |