Individual
CORLISS WENTWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
1601 E FOURTH PLAIN BLVD # 101, VANCOUVER, WA 98661-3713
(360) 397-8246
(360) 397-8450
Mailing address
2009 NE 117TH ST, 101, VANCOUVER, WA 98686-4022
(360) 566-9112
(360) 566-9133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005457
WA
Other
Enumeration date
04/24/2007
Last updated
03/25/2019
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