| |
7320 179th St Sw Edmonds WA 98026-5534 | |
(206) 321-9998 | |
Not Available |
Full Name | |
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Speciality | Social Worker - Clinical |
Location | 7320 179th St Sw, Edmonds, Washington |
Authorized Official Name and Position | Dessetta Smith (CREDENTIALING/BILLING) |
Authorized Official Contact | 4253874647 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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7320 179th St Sw Edmonds WA 98026-5534 Ph: (206) 321-9998 | 7320 179th St Sw Edmonds WA 98026-5534 Ph: (206) 321-9998 |
NPI Number | 1588278410 |
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Provider Enumeration Date | 09/08/2020 |
Last Update Date | 11/10/2021 |
Certification Date | 11/10/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588278410 | NPI | - | NPPES |
1477745719 | Other | WA | 1477745719 |
2195117 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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