Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00005177 | WA |
NPI | 1003183427 |
---|---|
Provider Name | Ms. Kimberley J Doyle |
First Address | Wellpinit, WA 99040-0540 |
Second Address | Wellpinit, WA 99040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 30/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1467644294 | (05) | WA |