Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | C4044 | OR |
Y | 101YM0800X | Mental Health Counselor | MC60418527 | WA |
NPI | 1003211350 |
---|---|
Provider Name | Sebastian Molfa |
First Address | Vancouver, WA 98661-7369 |
Second Address | Vancouver, WA 98661-7369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 06/10/2017 |