Individual
MIRELLA APOLONIA VILLAGOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CP60459149
Contact information
Practice address
5915 ORCHARD ST W, BLDG. B, TACOMA, WA 98467-3824
(253) 414-7461
Mailing address
5915 ORCHARD ST W, BLDG. B, TACOMA, WA 98467-3824
(253) 414-7461
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60459149
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1995208
—
WA
Enumeration date
01/22/2016
Last updated
01/22/2016
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