Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60696848 | WA |
NPI | 1003391723 |
---|---|
Provider Name | Mr. Ivar Sandsmark |
First Address | Seattle, WA 98125-6748 |
Second Address | Seattle, WA 98125-6748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2018 |
Last Update Date | 27/09/2018 |