Individual
AUTUMN IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP, CAAR
Contact information
Practice address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
(360) 423-5128
Mailing address
913 OLSON RD APT A, LONGVIEW, WA 98632-5467
(360) 270-1158
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG61313331
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP 60188084
WA
Other
Enumeration date
05/05/2017
Last updated
02/28/2023
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