Individual
DESTANIE TANAY GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
661 TAYLOR ST, PORT ORCHARD, WA 98366-4300
(360) 337-4625
Mailing address
614 DIVISION ST, PORT ORCHARD, WA 98366-4614
(360) 337-4625
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61104404
WA
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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