Individual
CONSTANCE SHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 14TH AVENUE, LONGVIEW, WA 98632
(360) 423-0203
(360) 577-0269
Mailing address
PO BOX 1847, LONGVIEW, WA 98632
(360) 423-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CG60474028
WA
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065847
—
WA
Enumeration date
10/28/2014
Last updated
04/07/2020
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