Organization
AUTHENTIC VIBRANCY COMPANY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WIESNESKE (OWNER)
(360) 420-5930
Entity
Organization
Contact information
Practice address
325 PINE ST STE B, MOUNT VERNON, WA 98273-5929
(360) 420-5930
(360) 499-2274
Mailing address
325 PINE ST STE B, MOUNT VERNON, WA 98273-5929
(360) 420-5930
(360) 499-2274
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/12/2025
Last updated
08/12/2025
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