Individual
NICOLE JACQUELINE TANNHEIMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BFA, CDP, NCAC I
Contact information
Practice address
1000 SW 7TH ST STE B, RENTON, WA 98057-5216
(206) 248-4358
(425) 430-9770
Mailing address
1000 SW 7TH STE. B, RENTON, WA 98057
(206) 248-4358
(425) 430-9770
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005781
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA400X
LAKESIDE MILAM RECOVERY CENTERS
WA
01
—
CD00005781
LAKESIDE MILAM RECOVERY CENTERS
WA
Enumeration date
12/19/2018
Last updated
12/19/2018
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