Individual provider · Type 1 NPI
Kenneth Stephen Bourque, CDPT
Addiction (Substance Use Disorder) Counselor · Tacoma, WA
NPI number
1326602822
Active
Practice location
5915 Orchard St W
Tacoma, WA 98467-3824
Fax (253) 627-8387
Mailing address
4329 Concordia Ln SE
Lacey, WA 98503-2150
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 60833994 (WA) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1326602822
Kenneth Stephen Bourque, CDPT's National Provider Identifier is 1326602822, issued on Apr 30, 2019. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Tacoma, WA. The record was last updated on Apr 30, 2019.