Provider Demographics
NPI:1437712486
Name:SARQUILLA, VERNA MICHELLE MONIQUE (BA)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:MICHELLE MONIQUE
Last Name:SARQUILLA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:VERNA
Other - Middle Name:MICHELLE MONIQUE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:165 E HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2629
Practice Address - Country:US
Practice Address - Phone:509-684-4597
Practice Address - Fax:509-684-5286
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60960052390200000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program