Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH60722538 | WA |
N | 101YS0200X | School Counselor |
NPI | 1245629393 |
---|---|
Provider Name | Stefanie Ann Davis |
First Address | Spokane, WA 99208-4736 |
Second Address | Spokane, WA 99208-4736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 01/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245629393 | (05) | WA |