Individual
MR. ROBERT GLENN LACK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, CDP
Contact information
Practice address
1010 E BRUNEAU AVE, KENNEWICK, WA 99336-3775
(509) 735-7410
(509) 783-5953
Mailing address
PO BOX 5697, KENNEWICK, WA 99336-0697
(509) 735-7410
(509) 783-5953
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
RC-00018500
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP-00001417
WA
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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