Individual
BLAKE CARENTON MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4425 ISSAQUAH PINE LAKE RD SE APT I14, SAMMAMISH, WA 98075-6247
(832) 943-7204
Mailing address
33010 SE 99TH ST, SNOQUALMIE, WA 98065-9797
(425) 831-2500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61411437
WA
Other
Enumeration date
05/01/2025
Last updated
05/01/2025
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