Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 104100000X | Social Worker |
NPI | 1003387416 |
---|---|
Provider Name | Nicole E Lairson |
First Address | Kennewick, WA 99336-2967 |
Second Address | Kennewick, WA 99336-2967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 19/12/2018 |