Individual
MS. JETTA KIMBERLY LUCIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
6926 E FOURTH PLAIN BLVD, SUITE #100, VANCOUVER, WA 98661-7369
(360) 993-3000
(360) 737-3451
Mailing address
PO BOX 1337, VANCOUVER, WA 98666-1337
(360) 993-3000
(360) 737-3451
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP 00004432
WA
Other
Enumeration date
06/15/2009
Last updated
07/24/2013
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