Healthcare Provider Details

I. General information

NPI: 1558191445
Provider Name (Legal Business Name): JEFFREY DUNCAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BRISTOL CT SW
OLYMPIA WA
98502-6004
US

IV. Provider business mailing address

510 TACOMA AVE S
TACOMA WA
98402-5416
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-2482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.70045506
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: