Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 60853457 | WA |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | LPC-3236 | ID |
NPI | 1184767600 |
---|---|
Provider Name | Pamela Rose Vanderdoes |
First Address | Auburn, WA 98092-3089 |
Second Address | Auburn, WA 98092-3089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 03/05/2020 |