Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP60091478 | WA |
Y | 1041C0700X | Clinical Social Worker | LW60455301 | WA |
NPI | 1003250960 |
---|---|
Provider Name | Ms. Kimberly Ann Miles |
First Address | Seattle, WA 98122-4201 |
Second Address | Seattle, WA 98104-3599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 01/03/2021 |