Healthcare Provider Details

I. General information

NPI: 1942858816
Provider Name (Legal Business Name): VICKIE FANFAN YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-7600
  • Fax: 206-695-7606
Mailing address:
  • Phone: 206-695-7600
  • Fax: 206-695-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC60971181
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61001779
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: