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1124506480
DEIDRA GRAVINA
VANCOUVER, WA
NPI
1124506480
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-07-30
Last Update Date
2018-07-30
Business Address
DEIDRA GRAVINA
6926 E FOURTH PLAIN BLVD
VANCOUVER, WA 98661-7254
Phone number: 360-993-3000
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Mailing Address
DEIDRA GRAVINA
PO BOX 1337
VANCOUVER, WA 98666-1337
Phone number: 360-993-3000
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