Healthcare Provider Details

I. General information

NPI: 1053441980
Provider Name (Legal Business Name): MARCO SANCHEZ M.A. MHP, CDP DVC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 N 105TH ST STE 101
SEATTLE WA
98133-8973
US

IV. Provider business mailing address

13527 DENSMORE AVE N
SEATTLE WA
98133-7738
US

V. Phone/Fax

Practice location:
  • Phone: 206-478-1191
  • Fax: 206-522-3920
Mailing address:
  • Phone: 206-478-1191
  • Fax: 206-522-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: