Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | C060734946 | WA |
NPI | 1003383167 |
---|---|
Provider Name | Mr. Benjamin Michael Valdez |
First Address | Wenatchee, WA 98807 |
Second Address | Wenatchee, WA 98801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2018 |
Last Update Date | 26/10/2018 |