Healthcare Provider Details

I. General information

NPI: 1750647475
Provider Name (Legal Business Name): DELTON LIONEL MOSBY MSW, MPH, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-4801
US

IV. Provider business mailing address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-7676
  • Fax: 206-725-7585
Mailing address:
  • Phone: 206-726-4100
  • Fax: 206-328-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP0006102
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: