Individual
JACQUELINE LICEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6845 S ALDER ST, TACOMA, WA 98409-5213
(253) 267-0085
Mailing address
PO BOX 111780, TACOMA, WA 98411-1780
(253) 267-0085
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFTA.MG.61408457
WA
Other
Enumeration date
01/03/2020
Last updated
03/04/2023
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