Individual
MRS. NICOLE LEE PATINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
1550 IRVING ST SW, TUMWATER, WA 98512-6358
(360) 507-8030
Mailing address
918 E MEAD AVE, YAKIMA, WA 98903-3720
(509) 575-8457
(509) 453-1273
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60601655
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP60601655
CDP
WA
Enumeration date
05/04/2018
Last updated
08/07/2019
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