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General NPI Number Information
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NPI Number | 1700335890
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Entity Type | Organization
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Legal Business Name | KOINONIA COUNSELING, PLLC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 615 N 2ND ST
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City | TACOMA
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State | WA
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Zip | 98403-2232
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Country | US
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Telephone | 253-292-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 615 N 2ND ST
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City | TACOMA
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State | WA
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Zip | 98403-2232
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Country | US
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Telephone | 253-292-6756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY CARR
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Credential |
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Telephone | 360-220-3299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 60667776
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License Number State | WA
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