Individual
JEREMY JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDP-T
Contact information
Practice address
758 ST HELENS AVE, TACOMA, WA 98402-3706
(253) 274-0484
(253) 274-1457
Mailing address
758 ST HELENS AVE, TACOMA, WA 98402-3706
(253) 274-0484
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60872001
WA
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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