Healthcare Provider Details

I. General information

NPI: 1750983243
Provider Name (Legal Business Name): ANDREW ENSOR MSW, LSWAIC, SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19010 68TH AVE NE UNIT C202
KENMORE WA
98028-2692
US

IV. Provider business mailing address

19010 68TH AVE NE UNIT C202
KENMORE WA
98028-2692
US

V. Phone/Fax

Practice location:
  • Phone: 206-947-6235
  • Fax:
Mailing address:
  • Phone: 206-947-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number61131015
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61010971
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: