Individual
VIRGINIA AGUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3639 MARTIN LUTHER KING JR WAY S, SEATTLE, WA 98144-6847
(206) 695-7600
Mailing address
3639 MARTIN LUTHER KING JR WAY S, SEATTLE, WA 98144-6847
(206) 695-7600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60978301
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2113063
—
WA
Enumeration date
09/24/2018
Last updated
11/07/2019
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