Individual
BREANNE ENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA, SUDP
Contact information
Practice address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61278775
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2156340
—
WA
Enumeration date
04/20/2020
Last updated
12/04/2023
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