Individual
JESIKA RICHANNE SAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
209 W MAIN ST, CENTRALIA, WA 98531-4245
(360) 748-4339
Mailing address
209 W MAIN ST, CENTRALIA, WA 98531-4245
(360) 748-4339
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61454157
WA
Other
Enumeration date
01/24/2020
Last updated
10/09/2023
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