Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP60068759 | WA |
NPI | 1003568049 |
---|---|
Provider Name | Mr. Ricky Rorie |
First Address | Spokane, WA 99223-7976 |
Second Address | Spokane, WA 99208-1038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |