Healthcare Provider Details

I. General information

NPI: 1083495436
Provider Name (Legal Business Name): DERYL WILLIAM DAVIS-BELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2313 3RD AVE
SEATTLE WA
98121-1711
US

IV. Provider business mailing address

2313 3RD AVE
SEATTLE WA
98121-1711
US

V. Phone/Fax

Practice location:
  • Phone: 206-256-9865
  • Fax: 206-256-2065
Mailing address:
  • Phone: 206-256-9865
  • Fax: 206-256-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00005435
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: