Individual
MARK ANTHONY MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1498 SE TECH CENTER PL, VANCOUVER, WA 98683-9591
(360) 567-2211
Mailing address
4105 E 16TH ST, VANCOUVER, WA 98661-6205
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60699712
WA
Other
Enumeration date
07/08/2013
Last updated
02/03/2025
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