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General NPI Number Information
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NPI Number | 1023761095
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Entity Type | Individual
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Provider Name | GESINA SNOW-MANTEI SUDPT
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 2817 WHEATON WAY STE 205
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City | BREMERTON
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State | WA
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Zip | 98310-3440
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Country | US
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Telephone | 360-373-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 WHEATON WAY STE 205
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City | BREMERTON
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State | WA
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Zip | 98310-3440
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 61260194
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License Number State | WA
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