Individual
MRS. JOY ELAINE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
1412 140TH PL NE, BELLEVUE, WA 98007-3915
(425) 747-7892
(425) 747-8348
Mailing address
24116 102ND PL W, EDMONDS, WA 98020-5716
(206) 801-7399
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP 00002626
WA
Other
Enumeration date
02/22/2012
Last updated
02/22/2012
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