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Individual
TIA PACE
Active
Individual
TIA PACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, SUDP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CAAR.CG.70018184
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO60936575
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61331644
WA
Other
Enumeration date
06/15/2022
Last updated
09/29/2025
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