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1306073515
JETTA KIMBERLY LUCIANO
VANCOUVER, WA
NPI
1306073515
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA CP 00004432)
Enumeration Date
2009-06-15
Last Update Date
2013-07-24
Business Address
Ms. JETTA KIMBERLY LUCIANO CDP
6926 E FOURTH PLAIN BLVD SUITE #100
VANCOUVER, WA 98661-7369
Phone number: 360-993-3000
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Mailing Address
Ms. JETTA KIMBERLY LUCIANO CDP
PO BOX 1337
VANCOUVER, WA 98666-1337
Phone number: 360-993-3000
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