Individual
DAMANI JEVON THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 W COTA ST, SHELTON, WA 98584-2265
(360) 205-8001
Mailing address
33032 26TH PL SW, FEDERAL WAY, WA 98023-2822
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710523568
—
WA
Enumeration date
01/17/2020
Last updated
01/17/2020
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