Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO 60660174 | WA |
NPI | 1003362401 |
---|---|
Provider Name | Simonne Marie Crooks |
First Address | Spokane, WA 99202-4855 |
Second Address | Spokane, WA 99202-4855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 26/08/2016 |