Healthcare Provider Details

I. General information

NPI: 1649457888
Provider Name (Legal Business Name): DAVID ALAN JOSEPHSON M.S., ACADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST
LEWISTON ID
83501-2141
US

IV. Provider business mailing address

PO BOX 761
CLARKSTON WA
99403-0761
US

V. Phone/Fax

Practice location:
  • Phone: 208-791-4925
  • Fax: 509-758-1028
Mailing address:
  • Phone: 208-791-4925
  • Fax: 509-758-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number45-100
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: