Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LH0000817 | WA |
N | 101YP1600X | Pastoral Counselor | LH00008817 | WA |
NPI | 1326131244 |
---|---|
Provider Name | Mr. George Frederick Hetherington |
First Address | Federal Way, WA 98003-6260 |
Second Address | Federal Way, WA 98003-6260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |