Individual
DODDIE A LAGERVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CP60310560
Contact information
Practice address
320 S KITSAP BLVD, PORT ORCHARD, WA 98366-3778
(360) 377-3776
Mailing address
PO BOX 960, BREMERTON, WA 98337-0212
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60310560
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP60310560
CHEMICAL DEPENDENCY PROFESSIONAL
WA
Enumeration date
09/22/2017
Last updated
09/22/2017
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