Individual
AUTUMN STAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSWAIC
Contact information
Practice address
2602 S 38TH ST, TACOMA, WA 98409-7303
(585) 730-0050
Mailing address
2602 S 38TH ST, STE A #270, TACOMA, WA 98409-7303
(585) 730-0050
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SC61340456
WA
1041C0700X
Clinical Social Worker
—
WA
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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