KIMMY JO LAKE

TACOMA, WA
NPI1629414917
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA  CP60311481)
Enumeration Date2013-05-14
Last Update Date2013-05-14
Business Address
Ms. KIMMY JO LAKE CDP
758 ST HELENS AVE
TACOMA, WA 98402-3706
Phone number: 253-274-0484
Mailing Address
Ms. KIMMY JO LAKE CDP
758 ST HELENS AVE
TACOMA, WA 98402-3706
Phone number: 253-274-0484
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