Doctor Name: | MARLA VIGRE |
NPI Number: | 1023298486 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | RC00048340 |
Business Practice Address: | 409 Custer Way Se Suite D Tumwater, WA - 985013350 |
Business Phone Number: | 3605708258 |
Business Fax Number: | 3605701171 |
Mailing Address: | Po Box 34703, SEATTLE |
State: | WA |
Postal Code: | 981241703 |
Phone Number: | 2067643335 |
Fax Number: | 2067640489 |
NPI Enumeration Date: | 11/13/2007 |
NPI Last Update Date: | 11/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | RC00048340 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |