Individual
MICHONNE PIEKSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2423 S GEORGIA AVE, CALDWELL, ID 83605-4477
(208) 455-1788
(208) 455-2044
Mailing address
2423 S GEORGIA AVE, CALDWELL, ID 83605-4477
(208) 455-1788
(208) 455-2044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LPC-5173
ID
101YP2500X
Professional Counselor
LPC-5173
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LPC-5173
—
ID
Enumeration date
10/09/2013
Last updated
10/09/2013
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