| NPI | 1497252019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DATHAN LANE Owner/Agent 253-750-2664 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-08-26 |