Individual
AMANDA MICHELLE GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
7507 NE 51ST ST, VANCOUVER, WA 98662-6007
(360) 906-1190
Mailing address
PO BOX 82819, PORTLAND, OR 97282-0819
(503) 233-5405
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60011896
WA
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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