Individual
MILES RAPHAEL WEISS GINGRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1905 CONTINENTAL PL, MOUNT VERNON, WA 98273-5633
(360) 755-6400
(360) 755-6407
Mailing address
10 LOGANBERRY LN, BELLINGHAM, WA 98229-4417
(505) 365-9160
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDPT.CO.70142848
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDPT.CO.70142848
SUDPT LICENSE FROM DOH
WA
Enumeration date
06/11/2026
Last updated
06/11/2026
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