KENNETH STEPHEN BOURQUE

TACOMA, WA
NPI1326602822
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA  60833994)
Enumeration Date2019-04-30
Last Update Date2019-04-30
Business Address
KENNETH STEPHEN BOURQUE CDPT
5915 ORCHARD ST W
TACOMA, WA 98467-3824
Phone number: 253-414-7461
Mailing Address
KENNETH STEPHEN BOURQUE CDPT
4329 CONCORDIA LN SE
LACEY, WA 98503-2150
Phone number: 360-350-2082
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