Individual
LICIA MONIQUE EMANUEL-MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDPT
Contact information
Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
(360) 423-5086
Mailing address
921 14TH AVE, LONGVIEW, WA 98632-2316
(360) 423-0203
(360) 423-2311
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60811079
WA
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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