Individual
BRANDON LABORICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
(360) 423-2311
Mailing address
921 14TH AVENUE, LONGVIEW, WA 98632
(360) 423-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
60770007
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2097783
—
WA
Enumeration date
10/10/2017
Last updated
02/05/2019
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