Individual
DESIRAE LAYNE NICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CG60864058
Contact information
Practice address
3901 S FIFE ST STE 301, TACOMA, WA 98409-7309
(253) 625-4422
(253) 584-1496
Mailing address
3901 S FIFE ST STE 301, TACOMA, WA 98409-7309
(253) 625-4422
(253) 584-1496
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CG60864058
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CG60864058
—
WA
Enumeration date
12/17/2018
Last updated
12/17/2018
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