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General NPI Number Information
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NPI Number | 1790194900
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Entity Type | Individual
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Provider Name | JANICE MARIE BARRERA CDP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 560 QUILEUTE HEIGHTS
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City | LA PUSH
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State | WA
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Zip | 98350
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Country | US
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Telephone | 360-374-4317
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Fax | 360-374-4319
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Provider Business Mailing Address
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Address Line | 2152 ALABAMA ST
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City | LONGVIEW
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State | WA
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Zip | 98632-1207
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Country | US
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Telephone | 360-374-4317
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Fax | 360-374-4319
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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 | 00000585
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License Number State | WA
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