Individual
SAMANTHA LA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDPT
Contact information
Practice address
28115 SE 451ST ST, ENUMCLAW, WA 98022-9204
(360) 640-5312
Mailing address
100 WELLNESS WAY, NEAH BAY, WA 98357
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60757690
WA
Other
Enumeration date
07/03/2017
Last updated
07/03/2017
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