Doctor Name: | MS. JACQUELINE AREVALOS |
NPI Number: | 1083034169 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CG60248969 |
Business Practice Address: | 10058 Peach Tree Pl Nw Silverdale, WA - 983839299 |
Business Phone Number: | 3607104483 |
Business Fax Number: | |
Mailing Address: | 10058 Peach Tree Pl Nw, SILVERDALE |
State: | WA |
Postal Code: | 983839299 |
Phone Number: | 3607104483 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2014 |
NPI Last Update Date: | 04/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CG60248969 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |