Individual
MARIA L MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP
Contact information
Practice address
1302 COMMERCE AVE, LONGVIEW, WA 98632-3096
(360) 423-2806
Mailing address
1302 COMMERCE AVE, LONGVIEW, WA 98632-3096
(360) 423-2806
(360) 423-5128
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
60723940
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61095293
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO60723940
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2101086
—
WA
Enumeration date
10/31/2017
Last updated
04/23/2024
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