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1952834095
MAVERICK MIRIAM TANG
BELLINGHAM, WA
NPI
1952834095
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Former Name
MIRIAM TANG
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA CP60993506)
Enumeration Date
2017-04-05
Last Update Date
2019-08-22
Business Address
MAVERICK MIRIAM TANG CDPT
515 LAKEWAY DR
BELLINGHAM, WA 98225-5233
Phone number: 360-676-2187
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Mailing Address
MAVERICK MIRIAM TANG CDPT
1610 LINCOLN ST APT 3
BELLINGHAM, WA 98229-6252
Phone number: 206-453-8501
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