Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 60345482 | WA |
NPI | 1003391954 |
---|---|
Provider Name | Mrs. Karen Jane Garvin |
First Address | Auburn, WA 98002-6719 |
Second Address | Tacoma, WA 98418-6813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2018 |
Last Update Date | 26/09/2018 |