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General NPI Number Information
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NPI Number | 1124501309
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Entity Type | Individual
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Provider Name | SAMANTHA VALLE CP60641068
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 515 W HARRISON ST STE 109
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City | KENT
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State | WA
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Zip | 98032-4403
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Country | US
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Telephone | 206-226-9435
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Fax |
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Provider Business Mailing Address
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Address Line | 34713 2ND LN S APT K134
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8719
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Country | US
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Telephone | 509-750-3859
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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 | CP60641068
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License Number State | WA
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