Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | RC00039617 | WA |
NPI | 1003007444 |
---|---|
Provider Name | Ms. Blanca V. Ibarra |
First Address | Tacoma, WA 98405-3332 |
Second Address | Tacoma, WA 98405-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 06/01/2010 |