Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00000646 | WA |
NPI | 1003382409 |
---|---|
Provider Name | Thomas C Davidson |
First Address | Yakima, WA 98901-2875 |
Second Address | Yakima, WA 98901-2875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2018 |
Last Update Date | 23/10/2018 |