Individual
MICHELLE BUCKHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP
Contact information
Practice address
621 GRADE ST, KELSO, WA 98626-2606
(360) 425-9210
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 425-9210
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60551022
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2088085
—
WA
Enumeration date
04/09/2015
Last updated
10/23/2023
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