Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | WA |
NPI | 1003214065 |
---|---|
Provider Name | Samantha Smith |
First Address | Lakewood, WA 98499-2858 |
Second Address | Lakewood, WA 98499-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2014 |
Last Update Date | 08/12/2014 |