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Individual
MR. ROBERT GLENN LACK III
Active
Individual
MR. ROBERT GLENN LACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, CDP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
RC-00018500
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP-00001417
WA
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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