Individual
MRS. MIRANDA JAKSHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP-T
Contact information
Practice address
900 FIR ST, LONGVIEW, WA 98632-2544
(360) 353-9422
(360) 575-1950
Mailing address
PO BOX 2429, LONGVIEW, WA 98632-8486
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61491028
WA
Other
Enumeration date
08/15/2024
Last updated
08/15/2024
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