Individual provider · Type 1 NPI
Robert Glenn Lack Iii, MA, CDP
Addiction (Substance Use Disorder) Counselor · Kennewick, WA
NPI number
1386877389
Active
Practice location
1010 E Bruneau Ave
Kennewick, WA 99336-3775
Fax (509) 783-5953
Mailing address
PO Box 5697
Kennewick, WA 99336-0697
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor | 101Y00000X | RC-00018500 (WA) |
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | CP-00001417 (WA) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1386877389
Robert Glenn Lack Iii, MA, CDP's National Provider Identifier is 1386877389, issued on Aug 25, 2009. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Kennewick, WA. The record was last updated on Aug 25, 2009.