Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO 60202212 | WA |
NPI | 1003364829 |
---|---|
Provider Name | Rebecca Peterson |
First Address | Oak Harbor, WA 98277-5809 |
Second Address | Freeland, WA 98249-8776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 31/07/2019 |