Individual
JEFFREY VANCE CARLISLE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Contact information
Practice address
3510 STEELHAMMER DR, CENTRALIA, WA 98531-4551
(360) 623-8020
(360) 623-1072
Mailing address
3510 STEELHAMMER DR, CENTRALIA, WA 98531-4551
(360) 623-8020
(360) 623-1072
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG60865261
WA
Other
Enumeration date
05/24/2019
Last updated
05/24/2019
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