Healthcare Provider Details

I. General information

NPI: 1588932313
Provider Name (Legal Business Name): CARLOTTA S DOSS SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

1135 24TH AVE S
SEATTLE WA
98144-3036
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60256005
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: