Individual provider · Type 1 NPI

Kimmy Jo Lake, CDP

Addiction (Substance Use Disorder) Counselor · Tacoma, WA

NPI number 1629414917 Active

Practice location

758 St Helens Ave
Tacoma, WA 98402-3706

Fax (253) 274-1457

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XCP60311481 (WA)

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

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About NPI 1629414917

Kimmy Jo Lake, CDP's National Provider Identifier is 1629414917, issued on May 14, 2013. 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 May 14, 2013.