Healthcare Provider Details

I. General information

NPI: 1326131244
Provider Name (Legal Business Name): GEORGE FREDERICK HETHERINGTON M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33309 1ST WAY SOUTH SUITE 203
FEDERAL WAY WA
98003-6260
US

IV. Provider business mailing address

33309 1ST WAY SOUTH SUITE 203
FEDERAL WAY WA
98003-6260
US

V. Phone/Fax

Practice location:
  • Phone: 253-952-2556
  • Fax: 253-952-6356
Mailing address:
  • Phone: 253-952-2556
  • Fax: 253-952-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH0000817
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLH00008817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: