Individual provider · Type 1 NPI

Miranda Jaksha, SUDP-T

Addiction (Substance Use Disorder) Counselor · Longview, WA

NPI number 1174355499 Active

Practice location

900 Fir St
Longview, WA 98632-2544

Call (360) 353-9422 Map

Fax (360) 575-1950

Mailing address

PO Box 2429
Longview, WA 98632-8486

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X61491028 (WA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1174355499

Miranda Jaksha, SUDP-T's National Provider Identifier is 1174355499, issued on Aug 15, 2024. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Longview, WA. The record was last updated on Aug 15, 2024.