Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00006062 | WA |
NPI | 1003367723 |
---|---|
Provider Name | Vickie Ellen Campbell |
First Address | Colville, WA 99114-2629 |
Second Address | Chewelah, WA 99109-8936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 18/10/2016 |