Individual
MR. NICKOLAS CASEY ROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
135 W MAIN ST, CHEHALIS, WA 98532-4817
(360) 748-4339
Mailing address
135 W MAIN ST, CHEHALIS, WA 98532-4817
(360) 748-4339
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60831015
WA
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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