Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO60776388 | WA |
NPI | 1003383597 |
---|---|
Provider Name | Ms. Cynthia Marie Brady |
First Address | Poulsbo, WA 98370-7087 |
Second Address | Poulsbo, WA 98370-7087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2018 |
Last Update Date | 01/11/2018 |