Individual
MARK CARL SIVESIND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
806 S VINE ST, PORT ANGELES, WA 98362-7982
(360) 452-2443
(360) 452-2738
Mailing address
806 S VINE ST, PORT ANGELES, WA 98362-7982
(360) 452-2443
(360) 452-2738
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61083927
WA
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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