Individual
SAGE BEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
1601 E FOURTH PLAIN BLVD BLDG 17, VANCOUVER, WA 98661-3717
(360) 397-8246
Mailing address
812 SE 136TH AVE UNIT G66, VANCOUVER, WA 98683-6982
(360) 989-4073
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61428672
WA
Other
Enumeration date
04/18/2023
Last updated
04/18/2023
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