Individual
DANIELLE DOMINIQUE FASTABEND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CBT
Contact information
Practice address
9414 NE FOURTH PLAIN BLVD, VANCOUVER, WA 98662-6109
(360) 892-5142
Mailing address
2408 SE GRACE AVE, BATTLE GROUND, WA 98604-8634
(360) 553-9917
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB0974695
WA
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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